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V 



V^A _ 




OF TH E 

-School of lA^edicine. 




THE HOSPITAL BULLETIN 



OF THE 

UNIVERSITY OF MARYLAND 



^/ 



VOL. VII. 



MARCH 15, 1911. 



-4^^<^ 



No. 1 



COINTEINTS 



ORIGINAL ARTICLES— 

Some Practical Points Regarding Fractures, 
with Special Reference to Internal Devices 
and the X-Ray — A. Aldridge Matthews. ... 1 

Tetanus— Alvin Clay McCall .S 

Fracture of Outer Third of Clavicle— S. E. 
McDaniel 12 

EDITORIALS 13 

The Advisory Alumni Council. 
Needs and Remedies. 
A New Year. 



ABSTRACTS H 

The Treatment of Acute Mania. 

Brief Summary of Arsenic Treatment of 
Syphilis Antedating the Modern Elirlich- 
Hata COG. 

Laboratory Report of University Hospital. . . IS 

ITEMS IS 

DEATHS 2u 







For V/ ' 

AMENORRHEA ^ 

DYSMENORRHEA 
MENORRHAGIA 

METRORRHAGIA 
ETC. 



ERGOAPIOL (Smith) is supplied only in 
packages containing twenty capsules. 

y DOSE : One to two capsules three 
\ or four times a day. -<■<-< 

\ SAMPLES and LITERATURE 
SENT ON REQUEST. 



c 

"i.'i 






^ 1 




The Hospital Bulletin 

IS THE PROPERTY OF THE 

Hospital Bulletin Company of the University of 

Maryland 

The Bulletin is conducted by a committee of the Hos- 
pital Staff, and will be devoted to the publication 
of Hospital material, to the educational interests of 
the University of Maryland and to the interests of 
the Alumni of the University, wherever found. Its 
functions will be educational and social, its promoters 
having in view the advancement of the educational worl5 
of the University from a clinical standpoint and the 
general welfare of the Alumni of the University by 
bringing them into more cordial relations and Into 
closer affiliation. 

Copies of Thb Bulletin will be sent during the year to 
every Alumnus whose address can be found. 

The Hospital Bulletin Company 
608 Professional Bldg. Baltimore, Md. 



A CARD 



Messrs. Hynson, Westcott & Co. are pleased to announce 
to the medical profession that they have Extended their 
Practice of Legilimate and Exclusive Pharmacy by open- 
ing a branch at Linden and North avenues. This Linden 
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tlieir patients. 

The attention of medical men in the counties is called 
to the facility with which they and their clientele may 
receive medicines and supplies, upon mail and telephone 
orders. 

TWO LOCATIONS: 

Charles and Franklin Streets 

Linden and North Avenues 



H\ Apparatus for Proctoclysis 



PEREGRINE WROTH, Jr., M.D., Hagerstown, Md. 

Previous to February, 1908, when the apparatus described below was devised by the writer, great 
difficulty had been encountered at the Union Protestant Infirmary, in the continuous administration of 
Salt Solution by rectum. The difficulties were; 

1. Proper control of rate at which the fluid was introduced into the rectum was apparently im- 
possible when gravity alone was depended upon. 

2. Patients almost invariably began to expel large amounts of fluid before the end of 12 hours 
after administration was begun. This was due either to too rapid or irregular introduction of fluid, or to 
irritation of Rectal Tube. 

3. Any obstruction to flow was not apt to be discovered for an hour or more, because if the Salt 
Solution is given slow enough to be retained, considerable time must elapse before an appreciable 
amount runs in. 

The Apparatus herewith presented consists of: 

1. A Metal Frame to hold Flask and Funnel. 

2. An Ordinary Glass Infusion Flask, Graduated in CC. 

3. A Stopcock with Short Rubber Connecting Piece. 

4. A small Glass Funnel. 

5. About 8 feet of Rubber Tubing, interrupted about 3 feet from lower end, and by Glass Con- 
necting Tube 8 inches in length. 

6. A tiny Soft Rubber Catheter I4F) connected to Rubber Tubing by Sharp-pointed Nozzle. 
This Apparatus is hung by Bedside, the catheter inserted from 3 to 6 inches within the Patient's 

Rectum, the Flask filled with Fluid, and the Stopcock adjusted so that the Fluid drops from the Flask 
into the Funnel at any rate desired. By the side of the Bed, on a Table or Chair, two water bottles 
filled with water heated to 212 degrees F. are placed on top of the other, and the tubing at the point 
where the Glass connecting piece is used, is laid between them. By this means the Fluid which is 
poured into the Flask cold is brought to body heat by the time it reaches the patient. The Frame 
holding the Flask and Funnel is now raised until the Fluid flows through the Funnel without back- 
ing up. 

The Ghas. Willms Surgical Instrument Co., 300 N. Howard Street, Baltimore, Md. 




SPECIFIC SKIN AFFECTIONS 



"I have had remarkable success in the treatment of tertiary syphilitic eruptions 
and ulcerations with Resinol Ointment," writes a prominent eastern physician. Con- 
tinuing, he says: "With its aid I healed an extensive ulceration of the skin covering the 
whole right side of the nose. This case had resisted all of the usual remedies, ' ' 

RESINOL OINTMENT is not disappointing, but on the other hand, 
brings results in all eruptions of the skin, whether specific or innocent. It 
is a most excellent healing dressing for skin ulceration, including syphilitic, 
varicose, or those resulting from deep burns. 

RESINOL OINTMENT will relieve the nerve-racking irritation of 
Pruritus Ani, or an infected Proctitis, quicker than anything else. This 
ointment contains no mercury, but combines readily with citrine and other 
of the mercurial ointments. It forms an excellent healing ointment base, 
in which any of the salts of mercury can be incorporated. 

RESINOL SOAP should be recommended for bathing all infected 
parts, or those exposed to infection. 

This excellent antiseptic also forms the basis of the medication in the 
Resinol Medicated Shaving Stick, the utility of which is obvious. 



Send for Samples 



Resinol Chemical Company 



BALTIMORE, MD. 



THE HOSPITAL BULLETIN 



Published Monthly in tW Interest of the Medical Department o£ the University of Maryland 
^<P:)^eE $l.o6 PER. ■YEAR 



Contributions invited from the Alumni of the University,"' 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., MARCH 15, 1911. 



No. 1 



SOME PRACTICAL POINTS REGARDING 
FRACTURES, WITH SPECI.AL REFER- 
ENCE TO INTERNAL DEVICES 
AND THE X-RAY.* 



Il}- A. Ai.DKiDCE Matthews, J\I.D., 

Class of lyoo. 

/ 'isitiii:^ Siiri^coii to St. Luke's Hospital. Spokaii..-, 

Il'asii. 



There has been considerable written in regard 
to the open method of treating fractures, but 
there is a great diversit_\- of opinion still pre- 
vailing. 

Dr. Lane claims that the open method should 
always be followed, when circumstances and con- 
ditions are favorable for such, but I certainly 
cannot agree with him in this matter. 

While there have been great strides made in 
bone surgery in the past fifteen years, I do not 
think it has advanced as much as surgery of the 
abdomen and other parts of the body, and the 
credit of this advance is much due to the efforts 
of Scudder, Downey, Hodgen, Simpson, Whit- 
man, Koche and many others who have con- 
tributed largely to this class of surgery, such as 
Krause. whose ambulatory treatment has added 
much to the coinfort of patients and unquestion- 
ably saved many lives, especially in the old, who 
would otherwise die of pneumonia if it were not 
that the\' could be moved about and move them- 
selves. 

Also the introduction of antiseptics, anesthesia 
and the X-Ray has made bone surgery compara- 
tively easy to what it was before. The X-Ray 
has been of great help in detecting obscure frac- 
tures and has heljied much in the reduction of 
fractures : at least we can be fairlv certain as to 
the position of our fragments and can be able to 
give a reasonably certain prognosis as to the re- 



* Read before thi? Spokane Medical Society. Spokane. Wash., 
February 2. 1911. 



suit. The X-Ray has also been responsible for 
many mal-practice suits, which, if it were not for 
this instrument, these suits would not be. And 
the reason for this is that we may have a per- 
fectly good and useful result with very little de- 
formity, but if we take an X-Ray we will see that 
the reduction was not perfect and our alignments 
are far from being anatomical, but we have a 
functionally good extremity 

The X-Ray cannot be taken as a criterion, for 
we must remember that the negative is only a 
shadow which is reflected upon the plate, and a 
man not accustomed to this special class of work 
is likely to interpret these shadows wrongly. The 
positions in which these pictures are taken are 
very important. A tricky X-Ray man might ex- 
aggerate a condition very much by knowing how 
to cast or reflect the shadow, and this introduced 
into court has great weight with a sympathetic 
jury, when in reality the deformity may be small 
and the result fairly good. 

Another great mistake which is often made 
with the X-Ray is by taking a negative in only 
one position ; this is shown by figures y-A and 
7-B. If this negative was taken in one position, 
as 7-A, and no other were taken, it would be con- 
sidered a fair alignment, but by taking it laterally 
you see it is far from being in good position. 

Then again, look at Fig. 3-B. There is a great 
overriding, and the patient did not know he had 
this deformity until he had seen the negative, 
and in this case, while I do not suppose it was 
intentional on the part of the attending physician, 
it was fortunate for the patient on account of the 
great shortening in the other leg. This case I 
will speak of later. Scudder has said an approxi- 
mate reduction that is non-anatomic, if followed 
b\- union and by a functi(jnall)- useful part and no 
a])i)arent deformity to the jjatient and his non- 
professional friends, is a good result. 

Coming back to the subject of operating on 
fractures, as a whole it should be condemned in 
my judgment. Of course, in many cases it should 



THE HOSPITAL BULLETIN 



be done ; for instance, when we cannot reduce the 
fracture, when there is interposing tissue be- 
tween the fragments, in oblique fractures where 




F'v^. 3-A. — Applioatiim of silvm- plate to fractured femur, 
taken several mouths after lieiug applied. 

the muscular contraction causes overriding, or 
in any condition where a fairly accurate reduction 
cannot be had and maintained. The most certain 




Fis. 3-B.— Old fracture of femur, showing strong union with 
great over-riding. The same patient as 3-A, liut opposite leg. 



by a radiograph that I was much mistaken. This 
has happened several times in fractures of the 
tibia, and in all of these cases I have usually had 
to resort to the open luethod to accomplish the 
desired result. 

The fracture of the patella is a fracture which, 
as a whole, under favorable conditions, should be 
treated by the open method. Other types of frac- 
ture which should come to operation to get good 
results are fractures of the neck of the femur 
(not in the old, but in the young) and those of 
the olecranon. But there are some who even 
condemn operating upon the patella, even though 
nearly always the ligament tears off not evenly 




I'is 



3C'.— Bene removed from middle third of femur (3-A> 
before appl.ving plate. 



way to determine this is by the X-Ray. Many 
times I have reduced fractures, at least thought 
I had, and after putting them up in splints found due to not liaving been properly reduced or onI\ 



with the bone and usually interposes between the 
fragments. 

Another mistake which I think we often make 
is that of trying to reduce fractures without an 
anesthetic. \\'e often fail to get a good reduc- 
tion while our patient is awake, for naturally he 
resists, even though imintentionally, and espe- 
cially is this a mistake if we cannot have a radio- 
graph to be certain after the reduction to see if 
the position of our fragments is in good align- 
ment. 

A verv much abused, if I might sa}', fracture 
is the Colic's fracture, and we often see bad de- 
formities following; this fracture, which is usually 

\' 



THE HOSPITAL BULLETIN 



partially so doing, ami here an anesthetic is prac- 
tically always necessary. 

I have a man here in town whose wrist I am 
ashamed of, not that he has not a perfectly useful 
hand, as practically all of them do get this, but 
he has a bad deformitx. Tiie only excuse I have 
to offer is that he was on a debauch w hich lasted 
some days after the accident, and it was a very 
hard matter to keep any dressing on his arm. 
Usually a properly reduced Colle's will remain in 
position and need but a light dressing. The 
dressing which I prefer is the plaster splint. 

The proper time to operate on fractures should 
vary. If a compound fracture, an immediate 



ance against microbic invasion. But there is one 
objection to this waiting, and that is the muscular 
contraction which so often occurs, which makes it 




Kig. 4-.\.— Fiactiu'etl til)i,i and fibula, taken tlircnish last. 

Operation should be performed if such is neces- 
sary to keep the fragments in position. In such 
fractures there is already a solution of continuity 
and it will not add anything to the danger of 
sepsis or the probability of death if we treat the 
fracture by the open method. sim]:)ly enlarging 
the wound already produced. Rut if not com- 
pound, it is better to wait a week or ten days, as 
Murphy has suggested, because the tissues are 
then in a condition of least resistance and after a 
week or ten days one can do an enormous amount 
of work without danger of infection, which could 
not be done on the day of the accident. The 
lymphatics have been cofferdammed and the new- 
capillaries are developed to the greatest resist- 




Kig. 4-B.— Sniiii' :.s 4-\, taken through plastei- cast after reduc- 
tion and application of silver piate. 

almost impossible to reduce our fracture, and it 
becomes sometimes mecessary to resort to my- 
ot()m\' and tenotomies, whicii is not alwavs an 




I'ij;. .?.— Hesuits following wiring of femur. Wire removed. 

advisable operation, although T had to do lo in 
one case, which Fig. 8 represents. 

There is such a thing as waiting too long, which, 



THE HOSPITAL BULLETIN 



no doubt, all of us who do surgery have seen, and 
that is bone softening, spoken of by A. F. Jonas 
as physiological bone softening. This being a 




Fis. C-A.— Lateral view of fractui-cd tiliia and fibula after re- 
duction. 



process of repair which takes place in bone, no- 
ticeable after two to three weeks, becoming more 
marked as time passes on, until the calcium salts 




Ki;r. )i-H. — Same as 6-A. anterior posterior view. 

begin to predominate and the density increases 
and the reverse process is carried on until the 
UDrmal density of the bone is re-established. This 



is one reason why splints, wires, nails, etc., do 
not hold and pull out easily when we operate 
upon old fractures, such as ununited fractures of 
six to ten weeks standing. This softening is 
shown very nicely with the X-Ray b\- the lesser 
density of th6 fractured extremities. 

In a new fracture any device which will hold 
the fragments in position is the correct one, 
whether externally applied splints or the applica- 
tion of internal devices. If it be the internal one, 
such as nails, screws, wire, staples, or what not, 
we must remember that they only hold for a short 
while and not until the union is complete. We 
usually have to remove these materials sooner or 
later, and they are always perfectly loose. I have 
many cases where these materials ha\e not been 




Kii;. 7-A.— Old fracture of femur, anterior posterior view. 

removed and some of several years standing. 
( )ne case has had silver wire in the tibia for eight 
\ears. 

The loosening- of these devices is due to the 
lime salt being absorbed around these foreign 
bodies, therefore we can only expect these ma- 
terials to act until the main factors cease to oper- 
ate, and that is muscular contraction, which is 
overcome in about one week, so by proper internal 
device and proper external support this can 
usually be accomplished. The materials that I 
am most partial to arc the silver plate, wire and 
nails, but on a number of occasions I have used 
silkworm gut, chromic gut, screws and celluloid 
linen. 



THE HOSPITAL BULLETIN 



The ivory screws (it Matjinison, spoken of by 
De Forest Willard, with nietalhc heads are con- 
siciercd very good, although I have never used 
tlieni. These screws are screwed into the bone 
and cut oft' flush w-ith the periosteum, and it is 
claimed thc\- soon become part of it. I feel a 
little skeptical about this and cannot see why they 
would be any more satisfactory than the metallic 
screws. 

I am not in a position to speak of the bone 
clamps for holding fragments in position, or the 
fracture devices which extend from the bone to 
the outside, as I have never used them. As a 
whole, for long bones, I prefer the silver plate 
held by screws, for it will hold and give, which 
the steel plates will not flii, and is less liable to 



After examining him 1 advised a resection and 
removal of about the middle third of his thigh 




Vi'^. .-P..— S;inu' !is 7-A. exi/t^jil takiMi hilrrall.v. 

pull out the screws if strain is put on, as can be 
seen in Fig. 3-A. See how the plate has bent. 

I would like to show you a few X-Ray nega- 
tives which will throw a little light upon what I 
have been talking about. 

Figs. 3-A and 3-B represent a man hurt in a 
wreck in which he had both legs fractured. I 
did not see him until about ten weeks after his 
injury, and at that time he had an ununited frac- 
ture of his right leg, with a great deal of crepitus 
and a number of sinuses running pus scattered 
all along his mid thigh. An amputation had 
been advised and he was sent here for that pur- 
pose. 




Fig. S-A.— Bowing of tilii.i mikI fi-ncturoil lower end fibula, 
anti.'rior posterior view. 




Fig. S-B.— Same as S-.\, iateral view. 

bone, for it was very plain to see that the fracture 
was comminuted and a quantity of dead bone 



THE HOSPITAL BULLETIN 



was present. The right leg was united as Fig. 
3-B represents. 

On September 21, irpg, I opened and removed 
two large spicules and then resected both of the 
ends of the femur, which you will see in Fig. 3-C. 
If 3'ou will notice, most of the bone removed is 




Fig. S-C— Same as S-A, after straightening tibia and resecting 
end of fibula. Kadiograpli taken tbrougli cast. 

dead and some of it had a worm-eaten appear- 
ance, showing absorption is taking place. Then 
I applied a silver plate with three screws below 
and two above, which is shown very well in plate 
Fig. 3-A. After a very protracted stay in the 
hospital he managed to get a good, useful leg 
which he can walk about on very well, although 
it is about six inches shorter than it was before 
the accident, but he wears a high shoe on this 
foot and uses a cane. Fortunately, the other leg- 
is about four inches shorter than it was formerly 
on account of the over-riding, which is shown in 
Fig. 3-B. This may be called a fortunate mistake. 

In Fig. 3-A the slight bending of plate and a 
little misplacement of ends is possibly due to the 
position in which it was put up following the 
operation, for there was naturally great mobility 
following the operation and the soft parts were 
puckered up in the middle thigh, which gradually 
contracted and took care of the slack. He is 
quite an active man now, and the plate is still in 
position and gives him no trouble. 

Figs. 4-A and 4-B represent a young man who 
had his leg broken by direct violence. 



I attempted to reduce this fracture, but could 
not, so put it up in plaster and had an X-Ray 
taken, which is shown in Fig. 4-A. The next 
day I opened down upon the fracture and tried 
to reduce, but on account of the muscular con- 
traction I could not do so, even though the frac- 
ture was not more than ten days old, so had to 
resect and applied a plate, which is shown in Fig. 
4-B. This man I kept under observation about 
three weeks, and he then went down in the coun- 
try. I have gotten most satisfactory letters from 
him and his physician. The X-Ray was unfortu- 
nately taken too high up and does not show the 
exact result following the application of the splint. 
It also shows a comminuted fracture of the 
iibula. I did nothing to this hone, for it only 
being for muscular attachment, etc., and I felt 
certain that it would get sufficient union without 
resorting to any operative treatment. 

This has been over a year and the plate has not 
given him any trouble, and his physician recently 
reported to nie he had an excellent result. 

Fig. 5. — Male, aged 28, fractured thigh, upper 
middle third. This man was anesthetized and 






Kig. 8-D.— Same as S-C, lateral view. 

fracture reduced and put up with traction, short 
inside splint and long outside splint, but after 
about nine weeks found he had no union, so 
opened down, freshened up the ends of the frag- 
ments, which were in fair apposition, and put a 
silver wire suture through the two fragments, but 



THE HOSPITAL BULLETIN 



this wire I had to remove about the tenth week 
after the operation un account of its setting up 
considerable irritation, and a sinus developed, also 
a small spicule of bone about the size of a pea came 
away and then the track immediately healed, and, 
as you see, he has a very good result, only a little 
thickening of the shaft. 

Figs. 6-A and 6-B.- — Male, age 34, shows 
nothing except a rather vuiusual fracture of the 
tibia and fibula and a good apposition, the kintl 
we would like always to get, it being com- 
minuted. 

Figs. 7-A and 7-B show strongly the great ad- 
visability of taking two views of a fracture. If 
we had only had the one, as Fig. 7-A, we would 
consider it a fair result, but by taking another 
view we find it is far from being what we want. 
This is a posterior deformity and does not incon- 
venience him, and he told me a few days ago he 
had just walked nine miles on it, and he was 
satisfied to leave it as it was. 

His attending physician at the time of his acci- 
dent was surprised, for he thought that he had 
gotten an excellent apposition, but the apposition, 
as it is plain to be seen, is very poor. The ultimate 
outcome and usefulness of his leg is good, even 
though the deformity is much, but being a convex 
deformity posteriorly it is not apparent to him. 

One disadvantage most of us have is the inabil- 
ity of having the femurs X-Rayed on account of 
not being able to get them to an X-Ray or an 
X-Ray to them to see the position of our frag- 
ments, for it is impossible to be absolutely certain 
that our fractures are always in correct apposi- 
tion, and I consider this one reason why so often 
there are ununited fractures of the femur. 

Fig. 8 shows the radiograph of a little girl, age 
five, who was referred to me on account of lame- 
ness. The child gives no history of ever falling or 
receiving any accident, although you can plainly 
see by the radiograph that she has a fractured 
fibula near the lower end. It is also very apparent 
that this had been done some time before on ac- 
count of the callus thrown out around the frac- 
ture. And, too, this child was inclined to walk 
upon the toe and turn the foot in. The tendo 
Achillis was very tight. I think possibly what 
must have happened was that the child had some 
time an accident, because the fracture could not 
be produced other than by violence, which frac- 
tured the fibula and bowed the tibia. I put the 



child to slee]5, fractured the tibia about between 
the middle and lower third, correcting the de- 
formity as much as I could ; also removed a small 
part of the fibula because it projected out and the 
skin was tight across it. 

Figs. 8-.\ and 8-B show leg before the opera- 
tion ; 8-C and 8-D show the leg a few days after 
the operation. I found it necessary to cut the 
tendo Achillis to hold the foot in proper position. 
I opened down on the tendon, cut it across, but 
not the sheath, and then put a celluloid linen 
mattress suture in the tendon, uniting it, or other- 
wise bridging the space over with the suture, 
leaving a gap of about one-half to three-fourths 
of an inch. This child has gotten a very good 
result, although I cannot say as to the ultimate 
outcome. It has now been about three months 
since removing splint, and result is apparently 
excellent. 



Dr. William Franklin Twigg, class of 1857, is 
one of the leading physicians of Allegany county. 
He was born in Allegany county April 14, 1857, 
the son of Francis Twigg and Catherine Gelich- 
man, and is of American-German ancestry. He 
obtained his early education in the public schools 
of the county and the normal school at Bedford, 
Pa. He , then taught school for nine years in 
Allegany county, and in 1881 matriculated at the 
University of Maryland, graduating from there 
in 1883. During his senior year he was a resi- 
dent student at the University Hospital. He 
began his professional career at Elk Garden, W. 
Va., and after practicing there for three years he 
located permanently at Cumberland, Md., where 
he has since lived. He married March 23, 1887, 
Miss Sarah M. Hetzel, of Cumberland, and has 
three children — Mirian Catherine, Ethlyn Mar- 
guerite and Nial Franklin Twigg. 

In politics Dr. Twigg is a strong Republican. 
He is surgeon to the Baltimore and Ohio Rail- 
road at Cumberland, and special surgeon for the 
legal department of the company. He is also a 
member of the board of pension examiners for 
Allegany county, and physician at Allegany 
County Insane Asylum. He is a member of the 
Medical and Chirurgical Faculty of Maryland, 
the American Medical Association, the Interna- 
tional Association of Railway Surgeons and the 
Allegany County Medical Society. 



THE HOSPITAL BULLETIN 



TETANUS.* 



By Alvin Clay McCall, 
Class of 19 1 o. 

Tetanus, or lockjaw, is an acute infectious dis- 
ease characterized by tonic, muscular spasms, gen- 
erally extensor in type, occurring at longer or 
shorter intervals, occasionally aggravated by 
clonic spasms, these being limited to the jaws or 
all the muscles of the body. 

ETIOLOGY. 

Tetanus is due to bacillus tetani, discovered by 
Nicolaier in 1884 and grown in pure culture by 
Kitasato in 1889. The organism is widely dis- 
tributed ; found in garden soil, manure piles, hay, 
etc. Occurs in dirty localities, especially among 
the negroes of the South, but also prevalent in 
Pennsylvania, Northern New York, New Jersey 
and Long Island, endemically in New Jersey and 
Cuba, and is a common sequence to the Fourth 
of July accidents. 

Tetanus gains entrance into the body most often 
through punctured or lacerated wounds, abra- 
sions, toy-pistol wounds ; in fact, any accident fol- 
lowing which the wound is contaminated with 
dirt. Has been seen to follow vaccination where 
contaminated with organisms and hypodermic in- 
jections of animal serum. Gains entrance in in- 
fants through umbilical cord. The wound fre- 
quently suppurates or sloughs before the symp- 
toms of tetanus appear. From point of inocula- 
tion the organism grows anerobically, elaborating 
toxins, which may spread so rapidly as to cause 
death in 24 hours (Holt). The toxins enter the 
motor end nerves, traveling by lymph and axis 
cylinder to spinal cord, then up the motor tracts 
to the medulla. The action of the toxins on the 
motor nerves directly and reflexly cause tonic con- 
vulsions, and on the sensory nerves cause clonic 
convulsions. 

PATHOLOGY. 

Pathology is very obscure; no organisms found 
in blood or internal organs. Membranes of the 
cord and brain are reddened ; small hemorrhages 
into the brain substance and muscles. Ganglion 
cells of the cord undergo degenerative changes 
(lesions which are common to many toxic dis- 
eases). 

SYMPTOMS. 

Incubation average is from 7 to 10 days ; one 
case reported 12 hours after accident (Kuhn) ; 

•Read before the LTniver.sity of Maryland Medical So- 
ciety, November 15, 1910. 



another four weeks (Groose). First is trismus of 
the jaw and difficult deglutition, followed by 
rigidity, jaw being set, and then followed by 
rigidity of the entire body. Occasionally the arms 
escape. Rigidity lasts at first from one to two 
minutes, occurring every 15 to 20 minutes, and 
then increases in frequency until it is continuous ; 
then produces the characteristic widespread tonic 
convulsions aggravated by clonic. Patient is in a 
hyperextended condition, opisthotonus position; 
face is drawn, set, eyes fixed, causing a peculiar 
sardonic smile. Speaks with difficulty, cannot 
swallow, mouth closed, obstinate constipation and 
retention of urine. The convulsions grow worse 
until each clonic spasm, fixing diaphragm and 
chest muscles, may cause death. Patient is in 
some unnatural position, face cyanotic, wet with 
perspiration, eyes bulging, countenance expresses 
deadly terror and sufifering. Each clonic spasm 
forces air out through the glottis, causing hissing 
scream. Spasms are due to peripheral irritations 
brought on by slightest cause, as drafts, speaking, 
weight of bed clothes, etc. In cases of recovery 
above symptoms become less severe and finally 
cease. If death, increase in severity. Tempera- 
ture normal, or 101° to 102", Pulse, high ten- 
sion rate, 80 to 100 per minute. Mind clear; in- 
somnia obstinate. 

Chronic tetanus comes on in from 10 days to 
several weeks ; spasms not so severe ; periods of 
relaxation permitting sleep. 

Cephalic Tetanus. — Spasms confined to the 
face, pharynx and neck. 

DIAGNOSIS. 

As it is impossible to isolate the bacillus in 
many of the cases, the diagnosis is based upon the 
characteristic tonic and clonic spasms beginning 
in the jaw and involving the body, the opisthot- 
onus, sardonic smile, clear mind and very low 
temperature, but may be confounded with hys- 
teria, strychnine poisoning, tetany and hydro- 
phobia. 

The following points are helpful in differen- 
tiating: 

I. Tetanus — History of Wound. — Muscular 
symptoms commence with pain and stififness in 
the back of the neck, twitching of the jaw, same 
being affected first, then rigid and set. 

Hysteria — History of E.vcitent Nature. — Mus- 
cular symptoms commence with rigidity of the 
neck, which creeps all over the body, affecting 



THE HOSPITAL BULLETIN 



the extrcniilies last; jaws set before convulsions 
and remain so between convulsions. 

Strychnia Poisoning — History of Taking Drug. 
Muscular symptoms come on rapidly, beginning 
in the extremities and body simultaneously; jaws 
last affected, and its muscles relax first after con- 
vulsions. 

2. Tetanus. — Persistent muscular rigidity, 
generally with a greater or less degree of perma- 
nent opisthotonus. 

Hysteria. — Persistent opisthotonus and intense 
rigidity between convulsions, lasting for a few- 
minutes. 

Stryclinia Poisoning. — Muscular relaxation be- 
tween convulsions : patient exhausted and sweat- 
ing. 

3. Tetanus. — Consciousness preserved until 
near death. 

Hvsfcriii. — Consciousness disturbed as second 
convulsion conies on and thereafter. 

.^trxehnia Poisoning. — Consciousness preserved 
unless death is imminent from suffocation. 

4. Tetanus. — Eyes open and rigidly fixed dur- 
ing convulsions. 

Hysteria. — Eyes closed during convulsions. 

Strychnia Poisoning. — Eyes stretched wide 
open. 

Tetany. — Milder nature of spasms, greater lim- 
itation of rigidity ; spasms begin in the hands and 
feet, but not in the jaw or neck. 

Hydrophobia. — Tonic spasms do not exist. 

PROGNOSIS. 

The longer the period of incubation, the less 
virulent the germ and the better chance of recov- 
ery. Mortality in young infants practically 100 
per cent. Mortality in all cases from 80 to 90 per 
cent. Average duration of disease, three and one- 
half days after active convulsions set in. 

TREAT.MK.XT. 

Prophyhiclic. — This is most important when we 
recall the fact that we have no specific treatment, 
and the mortality is from 80 to 90 per cent. All 
wounds sliould be treated antiseptically. If made 
with dirty objects, or if wounds have become con- 
taminated, they should be incised freely, cleansed 
and dressed antiseptically. Vaccinations and hy- 
podermic injections should be made antiseptically. 
Antitoxins should be given in all doubtful cases 
which are suspicious in doses of from 1500 to 
3000 units. Antitoxins have been proven experi- 
mentally to retard or prevent infection. As yet 



no harmful symptoms have been reported from 
the administration of same. 

Surgical Treatment. ■ — Always look for a 
wound. If found, incise, remove all necrotic tis- 
sue, disinfect, drain and dress antiseptically. 

General and Medicinal Treatment. — Patient 
should be kept in a quiet room, catheterized if nec- 
essary, bowels made to move by purgation or 
enema, and patient stimulated freely with alcohol. 
Nourishment given by mouth if possible ; if' not, 
by rectum. Medicinally, all drugs of cerebral or 
cord sedatives have been tried, with occasional 
recovery. Large and frequent doses of chlorals, 
bromides, morphia, calabar bean and cannibus iu- 
dica being used mostly. Antitoxin should be 
given in all cases, numerous cases of recovery fol- 
lowing its use being reported. The method of 
administration is unsettled, good results having 
followed intradural injections either in the cord 
or brain. Dose, 1500 to 3000 units, repeated daily, 
and in very severe cases two or three times daily. 
Ten c. c. of 25 per cent, solution of mag. sulph. 
injected intraspinally has been followed by re- 
peated recoveries, acting solely by its anesthetic 
effect on the cord, putting the patient at rest and 
saving him from exhaustion. The disadvantages 
of this, however, are the depressing effect on res- 
piration and the collection of mucus in the lungs. 
This can be largely eliminated by elevating the 
head and giving atropine. 

Hypodermic injections of emulsion or fresh 
brain matter has been recommended as the treat- 
ment to take up the toxins of tetanus, which has 
a mutual aflinity for nervous tissue. 

Carbolic acid in a solution of 3 per cent., in- 
jected deep, is supposed to render toxins inert. Ijut 
is doubtful. 

REPORT OF CASES. 

D. M. — Admitted October 24, 1910; in service 
of Dr. Hirsh. 

Age seven ; occupation, school girl. 

Family history negative. 

Past history negative to any acute disease : had 
jaundice when child; vaccinated September 13, 
1910. 

Present llhiess. — Thirty-three days after vacci- 
nation first signs of illness appeared. In the after- 
noon, October 18, 1910, on returning home from 
school, tripped over a stone and fell, cutting her 
lip. Walked home, but complained of feeling 
weak and stiff. She continued going to school 
the rest of the week. Three days later an erup- 



10 



THE HOSPITAL BULLETIN 



tion of small pustules appeared over the body. On 
Sunday morning complained of difficulty in swal- 
lowing ; later on in day began to have spasms, six 
to eight during the day. Nature of spasms : Jaws 
set and patient resting on back of head and heels, 
lasting a few minutes. Complains of being thirsty, 
and voids urine involuntarily during spasm. No 
spasm Sunday night. 

Was brought into hospital Monday afternoon, 
October 24, iQio, 39 days after vaccination and 
the second day of convulsions. Patient was in 
tonic spasms, aggravated at intervals of 15 to 20 
minutes by clonic spasms lasting three to five min- 
utes, condition having persisted all day. Patient 
is helpless and in excrutiating pain ; memory per- 
fectly clear. 

Pliysical E.vaiidiiation. — Patient is a female, 
white child, brought into the hospital in an ex- 
tremely filthy condition. Body covered with dirt 
and head entirely overrun v^'ith pediculi. Talks 
with difficulty ; mind is clear ; expression of ag- 
onizing pain. At intervals cries out for help. 
Rigid, and position is that of opisthotonus, due to 
tonic spasms, aggravated by the clonic spasms. 
Difficult swallowing, and swallowing seems to in- 
crease severity of spasms, face becoming cyanotic 

Scalp covered with heavy coating of light brown 
hair, entirely overrun with pediculi ; large number 
of small pustules over occipital region. 

Eyes are set; has peculiar stare. Conjunctivas 
slightly injected; pupils equal, react sluggishly to 
light and at times to accommodation. 

Face muscles rigid, producing peculiar sardonic 
grin. Contused-looking area site of carbuncle 
under right jaw. Mouth set; muscles of mastica- 
tion rigid ; not able to force open more than one- 
eighth inch. Cannot protrude tongfue. Teeth 
dirty, but sound. Impossible to examine throat. 

Neck : Rigid, hyperextended ; no palpable 
glands ; vessels stand out prominently. 

Chest : Hyperextended and rigid, covered with 
small pustules; respiration short, labored, and 
during clonic spasm is suspended from one-half 
to a minute. 

Lungs : Negative. 

Heart: Negative. 

Pulse; Increased tension ; rate, 125 per minute. 

Abdomen : Covered with small pustules, 
marked rigidity, board-like. Cannot make inden- 
tations with finger. 

LTpper extremity : Pcrfectl}- rigid : cannot bend 
elbows; manipulation of arms increases spasms. 



Small pustular eruption over arms, and on left 
one there is a necrotic scab, site of vaccination. 
On pressure, pus exudes from beneath scab. 

Lower extremities : Hyperextended ; cannot 
flex legs; painful to manipulation; knee reflexes 
absent. 

Nervous system : Mentally clear ; talks only 
with difficulty and indistinctly; cutaneous surfaces 
hyperesthetic. 

Examination increases severity of spasm. 

Temperature: Admission, 101.2°; for six days 
ranged between 99 and 103.4° ; since normal. 

Pulse: Admission, 122; for six days ranged 
between 100 and 150; since normal. 

Respiration : Admission, 28 ; for six days 
ranged between 20 and 30 ; since normal. 

TRU.-M'MENT AND COURSE OF DISE.\SE. 

Patient was given 1500 units of antitetanic 
serum, immediately after entrance, deep into the 
right gluteal region ; also given morphia, grain 
i-i2th. 

Patient was having tonic and clonic spasms 
every few minutes, ^\'ould have three or four 
clonic spasms every hour until midnight, when she 
was given another one-eighth of a grain of mor- 
phia, when clonic spasms ceased, but tonic spasms 
persisted. Restless entire night ; no sleep ; voids 
urine involuntarily. 

\\'as given 1^5 grains of calomel and yi ounce 
of mag. sulph. W. B. C, 16,000. P. N., 85 per 
cent. 

Second Day. — Rigid, but no clonic spasms. 
Drowsy at times ; does not want to be disturbed. 
Takes water and milk through a tube. Tonic 
spasms increase after two or three swallows, face 
Iiecoming cyanotic, lasting about a minute. Mor- 
phia, one-eighth grain, given in morning and 
evening ; castor oil, 3 drams : mag. sulph., i ounce ; 
vaccination scab removed ; cultures taken on agar ; 
one incubated and the other grown anerobically. 
Sore cauterized with carlwlic acid. 

Third Day.— Slept from 1 1 A. M. to 4 P. M., 
dozing at intervals thereafter. General appear- 
ance seemed better ; takes nourishment easier ; 
bowels moved freely after enema. 1500 units 
serum injected. Eyes washed t. i. d. with boracic 
acid and mouth with hydrogen pero.xide. 

Fourth Day. — Slept very little during night; 
general appearance brighter ; no complaint of 
pain ; frequently asked to have position changed ; 
mouth can be opened one-half inch; pulse good; 



THE HOSPITAL BULLETIN 



II 



agar cultures showed staphylococci. W. B. C, 
16,000. 

Fifth Day. — Slept very little ; can be handled 
without pain ; jaw muscles softer ; can open mouth 
three-quarters inch and move head from side to 
side; arms move slightly. Vaccination wound 
cauterized and dressed. Morphia, i-i2th grain 
given. 

Sixth Day. — Slept at intervals ; much brighter ;, 
can move head freely in all directions ; arms easily 
Ijent ; mouth open one inch ; eyes normal, except 
small pupils ; probably due to morphia. Morphia, 
5''^th grain given. 

Seventh and Eighth Days. — Slept at intervals ; 
opisthotonus disappeared ; no risus sardonicus ; 
bowels and bladder regular ; no bacilli isolated 
from anerobic culture. W. B. C, 14,000. H. B., 
74 per cent. 

Ninth, Tenth and Eleventh Days. — Improving; 
sleeps entire night : legs can be bent to right angle ; 
arms can be used to help herself ; sluggish knee 
reflexes ; mouth open to full extent. 

Twelfth, Thirteenth and Fourteenth Days.' — 
General appearance excellent. \V. B. C, 9000. 
Sat up in chair. 

Fifteenth, Sixteenth and Seventeenth Days. — 
Allowed to stand; complains of pain in legs; 
afraid to walk. 

Eighteenth Day. — Walked one step, but stiff. 

S. G. — Admitted October 6, 1909; in service of 
Dr. Hamburger. 

Age 32 years ; occupation, tailoring ; social con- 
dition, widow. 

Family history negative. 

Past history : Had thyroidectomy performed 
two years ago. Two weeks ago had taken drugs 
to bring on menstruation, which lasted for three 
days. Womb was then curetted, and hemorrhage 
stopped. Ulcer was found, which was cauterized. 

Present Illness. — Day before entering the hos- 
pital, about 12 days after curettement, patient 
awoke complaining of stiffness in the jaws, diffi- 
cult swallowing; talking is difficult, and had con- 
vulsive spells. Body bathed in perspiration, and 
complaining a great deal of pain. 

Admitted to hospital on October 7 at i A. M., 
having typical tetanic convulsions. Pulse weak ; 
did not respond to cord or cerebral sedatives. 

Admission temperature, 90° ; temperature 
ranged between 99 and 104^°. 

Pulse on admission, 120, ranging from 90 to 
160. 



Respiration on admission, 22, ranging from 20 
to 42. 

Patient ran a very severe course ; continuous 
spasms ; would not respond to sedatives. Patient 
was given 15 grains of bromide and 5 grains of 
chloral. No organisms isolated. 

Died on second day of convulsions, 27 hours 
after admission to hospital. 

M. K. — Admitted March 6, 1910; in service of 
Dr. Winslow. 

Age 14 years; occupation, factory hand. 

Family history negative. 

Past History. — Ten days prior to present ill- 
ness ran a rusty nail through the foot, which 
wound healed readily. 

Present Illness. — Symptoms began four days 
ago; that is, 10 days after incurring wound, with 
stiiTness and rigidity of the jaw, and rapidly de- 
veloping into general convulsions. Temperature 
on admission, 100.5°. Foi" three days tempera- 
ture ranged from 98 to 102°. From the fourth 
to the sixth day, from lOi^ to 1034^°. 

Pulse on admission, 102 ; for the first three 
days ranging from 80 to 130; fourth to the sixth 
day, from 80 to 135. 

Respiration on admission, 24; ranging during 
the six days from 20 to 40. 

W. B.C., 9600. H. B., 85 per cent. B. P., 120. 

Had severe course of convulsions, and only 
after large doses of sedatives were the spasms 
suppressed. No organism isolated. 

TREATMENT. 

First Day. — Wound in foot opened ; spinal 
puncture done under chloroform for cultures ; 
3000 units antitoxin serum injected. Patient was 
given 30 grains chloral and 60 grains bromide. 

Second Day. — Was given 6000 units of serum 
and 10 c. c. of 25 per cent, solution of mag. sulph. 
intradurally. 

Third Day. — Was given 6000 units of serum 
and 10 c. c. of 25 per cent. mag. sulph. 

Fourth Day. — Was given 6000 units of serum, 
40 grains bromide and 20 grains chloral ; spinal 
puncture done and 6 drams of fluid withdrawn; 
10 c. c. of mag. sulph. given. 

Fifth Day. — Was given 6000 units serum, 10 
c. c. of mag. sulph., 15 grains of bromide and 20 
grains of chloral. 

Last or Sixth Day. — 6000 units of serum. 

Received in all 30,000 units of serum, 70 grains 



12 



THE HOSPITAL BULLETIN 



chloral, 115 grains bromide and 30 c. c. of mag- 
sulph. Nothing seemed to quiet the case, and 
gradually weakened until death, which occurred 
on tenth day, after six days in hospital. 



I'R.VCTURE OF OUTER THIRD OF 
CLAVICLE. 



By S. E. -VIcDaniel, 
Senior Medical Student. 



The clavicle derives its name from its resem- 
blance to the old Roman key, "Clavis" Key. It 
is an S-shaped bone, situated between the head of 
humerus and scapula on outer side and sternum 
on inner side. 

I'rom its position and shape it can withstand a 
great deal of force. However, it is very liable to 
fracture, constituting- some 15 per cent, of all 
fractures of body. 

I'rom an anatomical standpoint, the clavicle is 
divided into three distinct parts — an inner, middle 
and outer third. In pi>int of frequency, the outer 
third seems the most liable to fracture. Rather 
just external to middle, where the inner or large 
curve meets the outer or small curve, at which 
point the bone is at its smallest diameter. Frac- 
tures of the outer end are more frequent than 
fractures of internal end, and much less frequent 
than fractures of the shaft. 

Fractures may occur at any age, but perhaps 
are more common before the age of six. It is said 
more than half the fractures occur before this 
age. 

It is caused b}- direct violence, indirect violence 
and, very rarely, muscular contraction. 

The symptoms are : 

Patient presents himself giving a history of 
injury to the shoulder. The peculiar way in which 
he is holding his arm and head would indicate 
that his collar-bone was injured. Likely he will 
be holding the elbow of injured side with hand 
of sound side, and pulling it against the chest. 
The head is turned down toward the shoulder of 
damaged side as if trying to listen to something 
ill joint, thus relaxing the pull of sterno-cleido- 
mastoid muscle upon inner fragment. He will 
also have other symptoms of fracture, namely, 
pain, deformity, abnormal mobility and loss of 
function. 



The pain will be increased by motion, pressure 
and hanging the arm down. The deformed 
shoulder will be shown by the pulling forward, 
inward and downward of the shoulder, with a 
reduction of the distance between the acromion 
and sternal end of clavicle. Abnormal mobility 
can be recognized by manipulating the fragments, 
and is usually accompanied by crepitus. 

The course of healing is usually uneventful, 
and union takes place within a month in adults, 
but some persistent deformity is the rule. 

Treatment consists in reducing the deformity 
by drawing or pushing the shoulder upward, back- 
ward and outward to its normal position, aided 
when necessary by pressure upon the projecting 
angle at point of fracture. The subsequent in- 
dication is to maintain the shoulder in this posi- 
tion, for the unsupported weight of the shoulder 
is the main cause of the displacement. This has 
been done satisfactorily in a great many ways. 
In children with a transverse, or a complete frac- 
ture, a simple sling for the forearm is often suffi- 
cient, but in oblique fracture of adults a per- 
fect result can rarely be obtained. In girls, when 
the least amount of deformity is desired, we 
place them on a smooth bed with a firm, nar- 
row pillow or cushion between the shoulders 
and the forearm resting on the chest. Sayre's 
dressing is in very general use. It requires two 
strips of adhesive plaster, each three inches wide 
and long enough to go once and a half around 
the chest. The end of strip is fixed loosely abiiut 
the arm of injured side, just below the axilla, and 
the strip is carried around the back and the op- 
posite side to chest in front, so as to hold the elbow 
a little behind the axillarv line ; the second strip 
is then carried from the top of shoulder on the un- 
injured side across the back to the opposite elbow 
up along the flexed forearm to the place of 
beginning, meanwhile pressing the elbow for- 
ward, inward and upward. .\ few turns of roller 
bandage about the arm and chest will give addi- 
tional support. In this and all other similar cases 
care must be taken not to allow the bare skin of 
forearm to rest oji that of the chest, in order to 
prevent maceration of the epidermis and even 
ulceration. Cotton wadding, linen or similar ma- 
terial should always be interposed between the 
two cutaneous surfaces. 

Other bandages ma\' be used for the purpose 
of holding the part in place, such as a figure of 
eight bandage of plaster of Paris. 



THE HOSPITAL BULLETIN 



13 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan WiNSLOwr, M.D., Editor 



Baltimore, Md., March 15, 191 1. 

THE ADVISORY ALUMNI COUNCIL. 

On February 28, 191 1, in the office of Mr. Wal- 
ter I. Dawkins, was born another link in the chain 
which is working toward the creation of a new 
and greater University of Alaryland. We refer 
to the Advisory Alumni Council, which began its 
formal existence on that date. It was certainly 
the privilege of a lifetime to attend the organiza- 
tion meeting of a body which in the future is of 
necessity bound to wield a powerful influence in 
shaping the destinies of our dearly beloved Alma 
Mater. Men from all walks of life were present — 
doctors, dentists, lawyers, pharmacists, etc. En- 
thusiasm was rampant in the fact that we had at 
last realized the fact that we were indeed going to 
be a factor in the internal direction of the Univer- 
sity of Maryland ; that we were going to be per- 
mitted to actually play our part as alumni and have 
a say regarding the policies of one of the oldest 
and noblest educational institutions in the United 
5tates. We were especially impressed with the 
fact that we were more or less burning bridges 
behind us and that the University of Maryland 
was entering into a new existence. Indeed, it was 
more or less celebrating a new birthday — a birth- 
day dedicated to progress. Such were our 
thoughts, and if we read the signs aright we are 
not to be disappointed. 

Although no definite lines of endeavor were 
laid down to follow at the first meeting, the Ad- 
visory Alumni Council did not waste time, but 
got down immediately to hard work. The presi- 
dent and secretary were chosen and inducted into 
office — Dr. B. Merrill Hopkinson and Mr. James 
W. Bowers, respectively. It was also decided to 
request of the Regents that they empower the va- 



rious Faculties that the Advisory Alumni Council 
be given a vote in the selection of professors. The 
chair was empowered, besides, to select commit- 
tees to investigate the feasibility and desirability 
of giving to the dental students a laboratory 
course in chemistry, another to look into the 
proper naming of the University buildings, and 
another still to seek a method to render the 
libraries more useful. We are only feeling our 
way, but expect to be able to render signal service 
to the old University. Anybody who has sugges- 
tions to make looking toward the betterment of 
our institution can do so with the assurance that 
the suggestion will be thoroughly investigated, 
and if thought wise and helpful will be brought 
to the attention of the University authorities. We 
are the connecting link between the Faculties and 
alumni, and hope that any alumnus who has the 
welfare of his Alma Mater at heart will avail him- 
self of this privilege by addressing the suggestion 
to the president of the Advisory Alumni Council 
of the University of Maryland, namely. Dr. B. 
Merrill Hopkinson, Professional Building, Balti- 
more, Md. 



NEEDS AND REMEDIES. 
We are doing business at the same old stand. 
We are preaching on the same old text. The 
needs of the medical school are so numerous that 
it is difficult to specify wherein we are most needy. 
Certainly the time has arrived for the establish- 
ment of certain departments upon a full time. 
paid basis. These are. especially, chemistry, 
anatomy, physiology and pathology. The profes- 
sors of these chairs should be scientists, and not 
practitioners of medicine. In our institution the 
department of chemistry is under the charge of 
two accomplished chemists, who are not phy- 
sicians, but it would be an exaggeration to claim 
that they were receiving adequate compensation 
for their services. The departments of anatomy 
and physiology are under the direction of erudite 
and enthusiastic teachers, who also receive inad- 
equate salaries, and who are engaged perforce 
in the practice of their profession as physicians. 
It is greatly to be regretted that these gentlemen 
cannot devote their whole time to the duties of 
their chairs, and the hope is entertained that cir- 
cumstances may so arrange themselves that this 
most desirable change may take place sooner than 
is now in expectation. At the present time the 
greatest need of the school is for an endowed 



14 



THE HOSPITAL BULLETIN 



department of pathology. The professor of 
pathology should not practice medicine for a liv- 
ing. His whole time and abilities should be given 
to pathological work and teaching, and he should 
receive a sufficient salary to provide for the necils 
of himself and his family. We have been solicit- 
ing contributions rather vaguely for an endow- 
ment fund ; let us now concentrate our efiforts 
and our beneficences definitely for the establish- 
ment of an endowed department of pathology. 
By a recent legacy the Faculty of Physic will soon 
come into possession of $5000. This should be 
devoted specifically to this purpose, and should 
form the nucleus of an endowment of the patho- 
logical department. We therefore ask our alumni 
and friends to help us to raise $100,000 for this 
special purpose. 



A NEW YEAR. 
The editor cannot start into a new year without 
thanking those who have made the existence of 
The Bulletin possible for six years — contrib- 
utors, subscribers and advertisers. It is the edi- 
tor's earnest desire that The Bulletin measure 
up to the expectations of its readers, and has 
endeavored to make it a first-class medical publi- 
cation. This is only possible by the loyal sup- 
port of our alumni, and can only be brought about 
by those interested in the success of the publica- 
tion occasionally sending us an article, a news 
item or by subscribing. Considering that we are 
in existence to give an outlet to the work of our 
alumni, and solicit papers from no other source, 
our paper certainly occupies an unique position, 
as the pages of most journals are open to the pro- 
fession in general. The Bulletin has steadily 
improved in tone and quality of articles published, 
and is performing extremely satisfactorily the 
object of its creation, namely, the drawing of the 
alumni into closer bonds of sympathy and the 
creation of an outlet for the work done in the 
University Plospital and by our alunuii in gen- 
eral, no matter where located. 



ABSTRACTS 



THE TREATMENT OF ACUTE MANIA. 

Charles P. Noble, M.D., Sc.D., class of 1884, 
of Philadelphia, in a paper on the above subject, 
Medical Record, says he wishes to present to the 
profession a new treatment of acute mania, based 



upon a theory of functional insanity, the nature 
of which he believes he has worked out. This is 
that functional insanity, so called, is due to the 
degeneration of the protoplasm of the cortex 
cells, and of those of the pituitary ganglion, 
which degeneration he has called molecular de- 
generation — as it is the degeneration of the units, 
or the elements, of which the cells are made up, 
as shown by the difference in the reaction to 
staining agents in these cells as compared with 
normal cells. 

The process whereby the molecular degenera- 
tion is produced is that of autointoxication, to- 
gether with hypesecretion of pituitary and of 
thyroid extracts. The intoxication is the result 
of the increased metabolism brought abotit by 
hyperthyroidism. The thought is relatively aber- 
rant and unvolitional, and the will is relatively 
exalted and is not under the control of the indi- 
vidual ; he has, relatively, lost self-control, or, in 
other words, the power of inhibition. 

It has been found that the principle and process 
are the same in both neurasthenia and in acute 
functional insanity. It is a question of degree, 
and not of kind. The irritation stage of neuras- 
thenia may be termed chronic unvolitional irri- 
tability, or chronic involuntary anger. Mania is 
the same thing, exaggerated "an hundred fold." 
Anger is the obverse of righteous indignation ; 
that is, the one is immoral and the other is moral. 
It is a disorder of the will, or the spirit, or the 
soul of man. The irritation stage of neurasthenia 
consists of unvolitional chronic irritation, or 
chronic anger. It manifests itself when the indi- 
vidual is acting, or doing, in outbursts of irrita- 
bility, or of anger, which is relatively beyond the 
individual's control — relatively, he has lost the 
power of self-control, and his thought is aberrant, 
in that in the irritation stage he is optimistic and 
in the stage of depression he is pessimistic, al- 
though he is rational. 

When the course of living — the environment — 
which has caused the neurasthenia is persisted in, 
the degeneration of the cells becomes nro^ressive, 
and their function becomes more and more mor- 
bid. The reserve vital force in the cells is more 
and more exhausted, and the potential energy has 
about all become actual. 

If now the individual continues to force him- 
self to do his work, the overworked, degenerated 
and exhausted cells react violently, and there is 
an explosion, called mania. 

The vicious circle consists of the following: 



THE HOSPITAL BULLETIN 



Of too much work, increased metabolism, chronic 
autointoxication, irritabihty and relative exhaus- 
tion of the will ; increased secretion of pituitary 
extract, increased secretion of thyroidin, followed 
by increased and aberrant thought, and progress- 
ively increasing autointoxication. 

The form of treatment which he has to suggest 
is that when mania first develops, the subject 
shall be given a hypodermic of morphine sul- 
phate — about one-third of a grain, repeated if 
necessary. This will temporarily c^uiet the pa- 
tient, when he should be anesthetized with 
nitrous-oxide gas and oxygen. If this is admin- 
istered properly, the subject can be kept asleep 
without risk for an indefinite period. The colon 
should now be filled with, approximately, three 
quarts of normal salt solution, and at the same 
time Jiypodermoclysis should be employed — fill- 
ing the subcutaneous connective tissues with, 
approximately, two quarts of normal salt solu- 
tion. 

If a suitable apparatus is employed, using 
three Y-tubes, four needles can be inserted at 
one time, and in this way the salt solution can be 
administered very promptly. 

This process can be repeated from time to 
time, as the condition of the patient indicates. 
There can be no objection to the refilling of the 
colon every eight hours, and at first the hypo- 
dermoclysis may be employed once daily. After 
two or three days it is probably better to intermit 
the employment of the hypodermoclysis, lest pres- 
sure necrosis of the connective tissues ensue. 

The patient should be kept in a drowsy condi- 
tion, or else asleep, by means of the administra- 
tion of hypnotics — sulphonal, trional, the bro- 
mides, morphine, hyoscine, etc. 

The object of the treatment is to break the 
vicious circle — to put the will in abeyance, 
whereby no nerve force shall be set free in the 
pituitary gland, and cause the secretion of the 
extract, and thus in turn, as this extract shall fail 
to stimulate the thyroid gland, thyrodin will not 
be produced, and thus in turn it will fail to reach 
the cells in the cortex of the brain, and thus the 
aberration of the thought so characteristic of 
acute mania will not be produced, and hence this 
thought, this judgment, or this form of nerve 
force will not set free that form of nerve activity 
which is called the will; hence the will will no 
longer be accelerated, but, on the contrary, as the 
patient should be kept in a drowsy condition, or 
else actually asleep, he will be will-less. 



If this treatment shall be kept up for several 
days the kidneys will be enabled to get rid of 
the accumulated toxins, and the patient will 
therefore become rational. The condition of 
acute mania will have been reduced to the period 
of convalescence from the irritation stage of 
neurasthenia. 

It is not the author's purpose in this communi- 
cation to supply the data in his possession. It is 
his desire to present this method of treatment to 
those who are engaged in treating the insane, in 
order that they may try it for themselves. He 
states that the form of treatment, if used with 
reasonable discretion, is without inherent danger. 



BRIEF SUMMARY OF ARSENIC TREAT- 
MENT OF SYPHILIS ANTEDATING 
THE MODERN EHRLICH-HATA 606. 
In a paper on the above subject by Professor 
Dr. med. Edward Ehlers, Copenhagen, and trans- 
lated by Dr. Ejnar Hansen, class of 1904, of New 
York {American Medicine) we glean the fol- 
lowing : 

Donrinc is the name of a disease in horses. 
For many years it has been the opinion of veter- 
inary surgeons that it was a kind of "horse- 
syphilis," or a disease very closely related to 
syphilis. 

Dourine (mal du coit, Beschals krankheit) is 
a chronic infectious disease attacking horses, don- 
keys and mules, and only communicated by coi- 
tus. It is now rarely found in Europe, all ani- 
mals suffering from it being immediately killed 
or castrated. It was first recognized in Tripoli, 
Algeria, Arabia and Persia ; a few cases can also 
be found in Hungary. In the United States it 
is sometimes found in Illinois, Nebraska, Wyo- 
ming and Dakota. Cases have also been found 
in the East Indies. 

Rouget first found the parasite in 1894, Doflein 
(Jena 1901) gave to it the name "trypanosoma 
equiperdum." The disease has three distinct 
stages. 

I. Eleven to twenty days after coitus edema 
starts around the lower edges of the preputium, 
it spreads to scrotum, inguinal region and often 
to the abdominal wall. It is cold and indolent. 
The temperature is 97 to 97.5°. In a few days 
this edema will disappear, but the animal is weak 
and it has difficulty in carrying its rider. 

II. {Eruption) 40 to 45 days after coitus there 
will be found on the sides and back infiltrated 
spots varying in size from a quarter of a dollar 



i6 



THE HOSPITAL BULLETIN 



to the size of the pahii of the liancl. It feels as 
though a flat piece of metal was imbedded under- 
neath the skin. These spots last from I to lo 
days. The horse becomes thinner, the hind legs 
lame, the joints soft, and large, swollen glands 
can be found in the inguinal region. 

III. (Aiiciiiia and paraplegia). The horse is 
very lame and has no appetite. Abscesses form 
which are very difficult to heal. There is con- 
junctivitis, ulcerative keratitis, distinct crepitus 
in joints; the bones are easily fractured. At last 
there is paraplegia and the horse dies. The 
length of the disease varies from 2 to 10 months. 

Treatment gives little result, but several authors 
praise arsenic as being of some benefit. (Trelut, 
Archawgelsky, Novikoff, Blaise,) Marchal (vet- 
erinary surgeon Constantine 1903) cured five 
horses suiTering from dourine by injecting so- 
dium cacodylate i gram dissolved in 4 cc. of 
water every day for five days, then omitting five 
days, and so on until the horses were cured. 
Dourine can be induced in dogs, rabbits, rats 
and mice by inoculation. Experiments on these 
animals showed that atoxyl had a specific effect 
on the disease. 

Atoxyl (Ehrlich 1907) was discovered 1863 
by a chemist in Montpellier by name Bechamp. 
Dr. Thomas, an English physician used atoxyl 
( 1904) for sleeping sickness. 

Uhlenhut, assisted by Hybener and Woithe 
from Kaiserlich gesundheitsamt in the winter of 
1906-1907, experimenting on rats, mice and rab- 
bits inoculated with dourine, showed that atox)l 
could cure the disease even in its worst form. 

Schaudinn, who discovered spirocheta pallida, 
experimented on owls, and in his last work, 
printed shortly before his death, gave us the 
theory that trypanosoma and spirocheta are only 
different steps in the evolution of the same cndo- 
globular hematozooa. 

This theory of Schaudinn started Uhlenhut 
experimenting with atoxyl on a topical spirocheta 
disease, the so-called chicken spirillosis. His re- 
sults were surprising. Atoxyl made the parasites 
disappear from the blood current in 8 to 12 hours, 
and the sick chicken became lively and well. Injec- 
tion in other chickens made them immune. These 
experiments were continued by Hoft'man in his 
atoxyl treatment of apes. 

Lesser in Berlin began treating human beings 
with atoxyl. At the same time similar experi- 
ments were made elsewhere by Neisser, Salmon, 
Hallopeau and ]\Ietchnikoff. 



Hoffmann's and Weidanz's experiments on rab- 
bits proved that atoxyl had a remarkable effect 
on S3'philis. Rabbits inoculated with syphilis in 
the eyes and at the same time treated with atoxyl 
did not develop keratitis syphiliticus. Other rab- 
bits with the same disease were entirely cured 
by the same treatment. Atoxyl did not, at that 
time, play any important role in the treatment of 
s\philis in human beings, because so large a dose 
was necessary that the patients were exposed to 
the well-known optic neuritis that claimed so 
many victims as a result of the atoxyl treatment 
of sleeping sickness. 

Uhlenhut and Manteuffel then tried a com- 
bination of arsenic and mercury, but this prepa- 
ration has as yet not proved very popular. The 
severe optic atoxyl-neuritis has kept the sxphilol- 
ogist away from this very interesting combina- 
tion which, when tried on animals, proved to be 
of much more value than atoxyl. 

Rosenthal made some experiments with acidum 
arsenicosum with satisfactory results. He tried 
it in 60 cases and used the following solution : 

.\cidi arseniosi centigram 8. 

Acoin 12. 

Aqua destill gram 40. 

From the above solution he injected one line 
(Pravaz) every third day, increasing the dose 
one line until the maximum dose of eight lines. 
He mentions one very severe case of syphilis of 
the roof of the mouth and the lower jaw, where 
the patient could not tolerate mercury. The case 
was cured with 0.544 gram of above solution 
injected during five weeks. 

Ehrlich has been more successful with his new 
preparation "606." According to the patent it 
is derived from atoxyl, but differs from it in 
name and chemical combination. 

It is a well-known fact that Ehrlich reformed 
our ideas of the chemical combination of atoxyl. 
It is he who first recognized it as parainiiio- 
phenylarsiiiacid, and from this discovery he syn- 
thetically reached "606." Dio.ry-diaiiiido-arsciio- 
bciicol-diclilorhydraic. 

In this combination arsenic is trivalent, and 
Ehrlich tells us that the pentavalent arsenic com- 
binations have less value than the trivalent 
("606" and arsenophenylglycin. ) It is a ques- 
tion if Ehrlich is right. The three most inter- 
esting pentavalent arsanilacids are : 

Atoxyl. — Paraminophenjl arsinite of Sodium 
24% Arsen. 



THE HOSPITAL BULLETIN 



Hektin. — Benzo-sulplionparaniimiphcnyl arsin- 
ite of Sodium 19% Arsen. 

Arsacetin. — Paracetylaminopheiiyl arsinite of 
Sodium 22.3% Arsen. 

The bad effect on the optic nerve has brought 
distrust to Uhlenhut"s atoxyl and arsacetin. That 
leaves us hektin. Hektin was discovered by 
!Moneyrath, professor in cliemistry at the L'ni- 
versity of L}on. He is known as an associate 
of Armand Gauthier, who first introduced Ar- 
rlicnal into the modern therapy. In 1904, wlien 
he wrote "L'Arscniqiic organiquc," he showed 
us that the step from Arrhenal ( JNIethylarsin So- 
dium) to ato.xyl was not a great one. 

After three years of experiments with these 
combinations on apes and rabbits inoculated with 
syphihs, hektin entered the syphiHtic therapeutic 
field through Balzer and Hallopeau. Moneyrath 
thinks that the poisonous effect and curative ac- 
tion of these arsenil compounds is increased by 
the weight of the aromatic nucleus. 

The aminoradical NH„ in the arsanilates in- 
creases the action of the aromatic arsinacid in 
such a way that the therapeutic dose is smaller 
tlian the toxic. 

The amin-group (NH„) can be replaced by 
hydroxyl with the same result. Two years ago 
iMoneyrath produced several of these combina- 
tions and published his methods in Bulletin fraii- 
cais. 30 juli 1908. He was the first to produce 
hydroxyaniinophenylarsinacid, which is the com- 
pound Plhrlich reduced and by which he gained 
his dioxyamidoarsenobenzol. Ehrlich was the 
first to use arsenic combinations in therapy, and 
knowing that acetanilid was less poisonous and 
better borne than anilin, he introduced the acetyl- 
ato.xyl-arsacetin. 

Moneyrath went another way. Pie tried to 
discoTer how the organism rendered benzol and 
anilin innocuous when introduced into the blood. 
Pie found that when a large dose is injected into 
the veins of a mammal, a part of it is disposed 
of unchanged, the other part is oxidized in such 
a way that benzol is converted into phenol (CeH^ 
to QH-OH), anilin to paraminophenol (QH^- 
OH/). 

While phenol is not thus rendered actually 
harmless and still remains as poisonous as benzol, 
we have the action of the glycuronic acid (COH 
[CHOH] 4 COOH) and potassium bisulphate 
combined with phenolhydroxyl forming the less 
poisonous potassium, phenol and aminophenyl- 
sulphates and glycuronates. 

To counteract the injurious action of the acids 



(benzoic acid and gallic acid) the organism uses 
the aminoforming action of the glycocoll and 
forms amides like hippuric acid. 

iMoneyrath was chiefly interested in the sul- 
phones uramides, urinary constituents, and after 
experiments on animals he decided that hektin 
and its mercury salt hektargyruni were the best. 
Hektin plays the same role in the therapy as ben- 
zoashydrarg, oxycyan mercury and other soluble 
mercury salts, and for that reason can be used to 
better advantage than "606," which coagulates 
albumin. For the same reason it produces hardly 
any pain, there is no redness, infiltration or indura- 
tion and it is not necessary for the patient to stay 
in bed. 

Hallopeau and Balzer (chief surgeons at St. 
Louis Hospital in Paris), Milan (Paris), Moniz 
de Aragua (Brazil), advise fractional doses of 
hektin, 10 centigram daily or 20 centigram every 
second day until z-t, gram has been injected. If 
complications set in, the injection can be stopped 
at once. 

Balzer in a large number of cases has only 
observed three cases of incipient amblyopia, which 
disappeared as soon as the injections w-ere 
stopped. The injections can be made intramus- 
cular, but also locally around the induration, the 
indolent glands, gummata or tertiary ulcerations. 
Hallopeau recommends the use of hektin in the 
manner as above described. 

^^'e now know that all attempts to destroy the 
chancre by cauterizatio\i or excision in order to 
stop the spread of the infection in the system 
have been futile, because the spirocheta immedi- 
ateljr invades the lymph-channels from the place 
of infection. Hallopeau's method of injecting 
hektin around the initial lesion seems to open the 
way to new victories over syphilis. Where the 
spirocheta can enter, hektin can also enter. Evi- 
dence gathered by the above-named men, all well 
known to syphilologists all over the world, show 
that when hektin is injected early enough around 
the chancre, and the lymphangitis or indolent 
adenitis, it will stop the development of the sec- 
ondary symptoms. Hallopeau has observed a 
patient cured by hektin who acquired a fresh 
infection. 

It must be remembered that all arsenic com- 
binations are vasodilators, so hektin should not 
be used when there is arteriosclerosis. Balzer 
advises against the use of hektin where the patient 
suffers from disease of the retina or nervous op- 
ticus. 

I Jiave been corresponding with Profegsor Ehl- 



i8 



THE HOSPITAL BULLETIN 



ers in regard to hektin, and he tells me that he 
has used the remedy in about 56-60 cases, is very 
well satisfied with it and considers it slow, but 
also a remedy to be depended upon. It is better 
adapted to office use than "606," the injections are 
painless and it can be injected as it is received in 
ampules, without any extraordinary preparations 
or mixing. It is made by the Hektin Company 
in Paris, and no doubt any physician can obtain 
it, either directly or through some reputable drug 
house. 



LABORATORY REPORT OF UNIVERSITY 

HOSPITAL. 

February ist to 28th, inclusive. 

BLOOD EXAMINATIONS. 

Leucocyte counts 191 

Erythrocyte counts 16 

Differential Leucocyte counts 7 

Hemoglobin determinations 98 

Smears for Malarial Parasites 12 

Widal Tests 11 

Wassennan Tests 20 

Blood Cultures 10 

Coagulation time 4 

369 

URIXE EXAMINATIONS. 

Routine Urinalysis 412 

(This included chemical tests for Al- 
bumin, Bile, Blood, Widal, etc., and in a 
great many the total estimation for Al- 
bumin and Urea. In every case a micro- 
scopical examination was made.) 

MISCELLANEOUS. 

Gastric Contents — 

Chemical-Microscopical Examination ... 11 

Feces — 
Macroscopical, Microscopical, and in 

some cases Chemical Examination. . . 17 

Sputum Examination 26 

Bacteriological Cultures and Smears. . . 15 

Examination of Spinal Fluid 4 

Sections of tissues for Microscopical 

Examination 30 

Autopsies 2 

105 

Total 886 

Dr. J. L. HiRSH, 
Dr. H. J. Maldies, 
Dr. R. Diller. 



ITEMS 

Dr. Max Kunstler, class of 1907, has purchased 
the house 2701 Eastern avenue, where he will 
make his home. 



In a letter from Dr. Joseph Angelo Devlin, class 
of 1906, of 168 W. 87th street, New York, we 
read : 

"Enclosed please find report of a case occurring 
in my private practice. Perhaps it will be of 
sufficient interest to publish in The Bulletin. 
I hope you can read my writing, but I shan't 
blame you if you fail, because I can hardly read 
it myself sometimes. 

" 'Bill' Hala of 1905 and yours truly are at- 
tempting to preserve the health and deplete the 
pocketbooks of the people of the West Side, so 
you will forgive me if I say good-bye and get 
back to the fray. 

"Sincere regards to all who remember me." 



Dr. W. Cuthbert Lyon, class of 1907, wlio has 
resigned bis commission in the United States 
Army J\Iedical Corps, owing to ill-health, has re- 
turned to Baltimore, and in the near future will 
open an office in one of the suburbs. 



At the meeting of the Faculty of Physic, held 
on March 7, the matter of raising funds for the 
Department of Pathology was earnestly consid- 
ered, and the following gentlemen were appointed 
a committee for this purpose : Profs. Randolph 
Winslow, John C. Hemmeter, Arthur INl. Shipley. 



Prof. Randolph Winslow has been appointed 
by the Provost a member of the Committee on 
Relations with St. John's ; Drs. Hemmeter, Ashby 
and Mitchell members of a Committee on Trus- 
tees. 



Dr. Joaquin S. Miranda, class of 1908, is Medi- 
cal Inspector to the City Health Department of 
Santiago, Cuba. 



Dr. John G. Hollyday, class of 1868, has been 
compelled to go to Florida, owing to ill-health. 



Dr. Houston Boyd Hyatt, class of 1907, of 
North Carolina, is a patient at the University 
Hospital. 



Mr. G. Y. Massenburg, class of 19x1, has been 



THE HOSPITAL BULLETIN 



19 



appointed one of the resident physicians at the 
Church Home and Infirmary. Dr. Massenburg 
won this distinction by competitive examination. 



Mr. Richard C. Dodson, class of 191 1, has been 
appointed assistant resident physician at the He- 
brew Hospital for the coming year. 



Dr. Robert Parke Bay, class of 1905, has been 
selected by Adjutant-General Warfield of the 
Maryland National Guard as one of the men 
whose names were submitted to the War Depart- 
ment to observe the maneuvers of the army now 
mobilized in Texas. 



Messrs. Joseph Enloe Thomas, Paul Pressly 
McCain, Herbert Augustus Codington, William 
Clinton Marett, and Grafton Dent Townshend, 
all of the present senior class, have through com- 
petitive examination been appointed resident phy- 
sicians at Bayview Hospital. 



Dr. William D. Cawley, class of 1902, of Elk- 
ton, Md., is a member of the medical staff of the 
Union Hospital in Cecil county. His services 
will be given during the months of March and 
August, 1911, and January and June, 1912. 



Among the consultants at the Union Hospital 
in Cecil county are the following University grad- 
nates: Drs. Randolph Winslow, class of 1873; 
St. Clair Spruill, class of 1890; Robert L. 
Mitchell, class of 1905, and Alexander D. Mc- 
Conachie, class of 1890, all of Baltimore, and Dr. 
Granville Hampton Richards, class of 1908, of 
Port Deposit. Drs. Winslow, Spruill and Rich- 
ards are consulting surgeons, Dr. Mitchell as- 
sistant consulting gynecologist, and Dr. McCon- 
achie consultant on ear, eye and throat diseases. 



Dr. Robert Parke Bay, class of 1905, has been 
appointed lecturer on oral surgery in the depart- 
ment of dentistry of the University of Mar\'land. 



Dr. Louis Hamilton Seth, class of 1908, was a 
recent visitor in the University Hospital. 



Dr. Josiah Sheer Bowen of Mount Washing- 
ton, class of 1903, read a paper entitled "A Bio- 
graphical Sketch of Dr. William G. Bodie," at 
the regular meeting of the Baltimore County 
Medical Association, held at the Guild House, 
Towson, March 15, 191 1. 



Dr. Norman T. Kirk, class of 1910, assistant 
resident physician in the University Hospital, 
who recently had his tonsils removed, is suffi- 
ciently recovered to resume his duties at the 
hospital. 



Dr. Summerfield Bond, class of 1883, is a pa- 
tient at the University Hospital. 



We are glad to report that Dr. St. Clair Spru- 
ill, class of 1890, who has been quite ill, has so 
far improved as to be able to resume his practice. 



We are glad to report that Mr. William Clinton 
Marett, class of 191 1, who has been a patient in 
the University Hospital, has returned to his stud- 
ies much improved. 



Dr. Erasmus Helm Kloman, class of 1910, 
assistant resident gynecologist, is a patient in the 
University Hospital. 



Dr. Benjamin Franklin Tefft, Jr., of Anthony, 
R. I., class of 1905, read a paper on "Sepsis" at 
the regular monthly meeting of the Kent County 
(R. I.) Medical Society, held at Arctic, R. I., on 
February 9. Dr. Tefft is medical examiner for 
the first district of Kent county. 



The Red Springs (N. C.) Citizen publishes a 
portrait of Dr. Roscoe Drake McMillan, and 
gives an account of the McMillan Sanitarium, 
which was opened in Red Springs on January 
iSth of this year by Drs. R. D. McMillan, class of 
1909, Benjamin F. McMillan, class of 1882, and 
John Luther McMillan, class of 1881. The Citi- 
zen says : 

"The present sanitarium, which is located in 
the Grantham building, is provided with ten 
rooms for patients ; an operating-room and a 
laboratory for pathological work are features of 
the institution, the former being equipped with 
the most modern appliances known to scientific 
surgery, and the latter having every facility for 
the examination of the blood for disease germs. 
Dr. R. D. McMillan, the resident surgeon, re- 
ceived his diploma in 1909, when he was ap- 
pointed assistant resident surgeon in charge of 
the Maternity Hospital connected with the Uni- 
versity of Maryland, which position afforded a 
splendid opportunity for the development of both 
skill and knowledge in the practice of both medi- 
cine and surgery amidst conditions and under 



20 



THE HOSPITAL. BULLETIN 



circumstances that tested ability. Last year, after 
serving one year in this capacity, he returned to 
his home and took up the practice of medicine 
among tiie people of his town. Drs. B. F. and 
J. L. McMillan are graduates of the same uni- 
versity and have been practicing here for many 
years. Mrs. Mattie Smith, the superintendent of 
the sanitarium, is a graduate nurse of the Mor- 
gantown State Hospital, at Morgantown, N. C, 
and has served in the Watts Hospital at Durham 
and at the A. C. L. Hospital at Rocky Mount, 
N. C. 

"It is proposed to erect a three-story building 
along the railroad tracks for the treatment of 
white patients and to use a building already 
erected for colored people, while the building 
now in use will be devoted to the use of Indian 
patients. This will give this entire section hos- 
pital facilities second to none in the State, and 
operated by a corps of physicians and surgeons 
who have the confidence and esteem of the entire 
community, the direct reward of their pronounced 
skill and knowledge and of the integrity that 
characterizes all their relations in both a profes- 
sional and civic capacity." 



Dr. John C. Hemmeter, class of 1884, delivered 
the annual oration at the meeting of the Pennsyl- 
vania Branch of the University of Maryland 
Alumni Association, held in Harrisburg, Febru- 
ary 23, 191 1. 



Dr. Daniel St. Thomas Jenifer, class of 1904, 
formerly of Atlantic City, N. J., has removed to 
Towson, where he will engage in practice. 



Dr. Richard C. Massenburg, of Towson, class 
of 1884, has entirely recovered from his recent 
illness. 



Dr. Josephus A. Wright, class of 1881, assistant 
superintendent of the Eudowood Sanatorium for 
Consumptives, has resigned and will practice in 
Towson. 



Dr. Samuel Claggett Chew, class of 1858, was 
re-elected president of the board of trustees of 
the Peabody Institute at the meeting held Febru- 
ary 13th. 



Dr. Howard J. Maldies, class of 1903, has been 
made lecturer on pathology and bacteriology in 
the Department of Dentistry of the University. 



Dr. George W. Dobbin, class of 1894, has been 
awarded $3,800 damages for injuries received in 
an automobile collision. 



Dr. Willard James Riddick, class of 1905, as- 
sistant surgeon, U. S. N., has been detached from 
the South Carolina and ordered to the naval sta- 
tion at Guantanamo, Cuba. 



DEATHS 



Dr. George William Mahle, class of 1905, died 
at his home, 1903 West Baltimore street, Febru- 
ary 20, 191 1, of tuberculosis. Dr. Mahle was 29 
years of age. After his graduation he became 
resident physician at Bayview, and resigned one 
year later to become a surgeon in the Robert 
Garrett Hospital, which position he held until 
his death. Dr. Mahle was very popular among 
the University men, and his death is deeply re- 
gretted. He had been seriously ill about two 
weeks. lie is survived by his mother, one brother 
and four sisters. 



Dr. David Marshall Devilbiss of Woodville,, 
Frederick county, Md., died at his home Febru- 
ary 14, 191 1, from nephritis, aged 66 years. Dr. 
Devilbiss has practiced in Frederick county since 
his graduation. He was born near Liberty, Md., 
April 3, 1845, the son of Adam A\'ashington and 
Rosanna Devilbiss, both natives of Maryland. 
His ancestors were Huguenots who fled from 
France during the French Revolution and found 
refuge in Germany, afterwards coming to An- - 
ica. Dr. Devilbiss obtained his earlier education 
at Little Hill Academy and Dickinson College. 
His preceptor in medicine was Dr. Thomas W. 
Simpson of Liberty, and he entered the medical 
department of the University of Maryland in 
1870, graduating in 1872. He practiced first at 
Liberty, then for a year at Adamstown, then 
returned to Liberty, formed a partnership with 
his preceptor. Dr. Simpson, and continued in s'jch 
relationship for seven years. In 1881 he loc. ted 
at Woodbine, where he has since remained. He 
has served as health officer of Frederick county 
and as State Senator from Frederick. He was a 
member of the Medical and Chirurgical Faculty 
of Maryland and the Frederick County Me :cal 
Society. Dr. Devilbiss married Miss L. M. Clary, 
He is survived by his widow and three children, 
Marguerite T., Edna C. and Roger M. Devilbiss. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 

trice; $x.oo per year 



Contributions invited from the Alumni of the University, 
Businiss Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., APRIL IS, 1911. 



No. 2 



A PATHFINDER IN THE ETIOLOGY 
AND PROPHYLAXIS OF 
YELLOW FEVER, 

HENRY R. CARTER, M.D., LL.D. 

Sl'RCEON LNITED S 1 ATES PCBLiC HEALTH AND MARINE 
HOSPITAL SERVICE. 



By JuHX C. Hemmeter, J\I.D., Phil.D., LL.D., 

Professor of Physiology^ University of Maryland, 

and 

Xath.\n Winslow, B.A., AI.D., 

1 

Associate in Surgery, University of Maryland. 



Goethe once classified the various kinds of na- 
ti-,re contemplation in a comprehensive way ". ( i ) 
The lowest grade is represented by the "Xutacn 
suclwndcn." the utility-seekers who apply that 
which nature otters for their utilitarian purposes. 
(2) The second are the "Wissbegierigen," or 
those simply eager for knowledge — the '"curious 
for nature." Cs) The third are the "Auschauen- 
den. ' who seek to avoid imagination as far as 
pos'-'ble and reduce everything to intuition (from 
the i^atin "intueri," to look on or into). (4) The 
fourji group are die "LTmfassenden" ; these minds 
operate in the opposite manner from the "intui- 
lionalist," for they start from preconceived ideas 
and seek to encompass (umfassen) their problem 
by a seeking of a realization of their own ideas 
in nature. 

This classification is a helpful one in endeavor- 
ing tp understand great minds like that of H. R. 
Carti,.r. 

Tl ; discovery of the transmission of the dis- 
covery of yellow fever has been credited, and 
justly so. to the work of Lazear, Reed and Car- 
roll, the latter a member of the class of 1891 of 
the ,; Medical Department of the University of 
iMaryland. These men, it is true, carried out the 
experiments which ultimately led to the detection 
of the manner of conveyance by which yellow 
fever is communicated from one individual to 



another. No fair-minded man can deny this fact, 
but one name which is closely linked to this 
epochal discovery has been singularly overlooked 
— that of Henry R. Carter, class of 1879. His 
work was no less important than that of the three 
above mentioned. Therefore we gladly tender 
this tribute with the view of placing on penna- 
iient record the exact part played by Carter in 
the investigation of yellow fever. 

Dr. Henry R. Carter is a native of Virginia ; 
attended the University of Virginia three years ; 
studied medicine at the University of Maryland, 
taking the degree of Doctor of Medicine therein 
in 1870. He entered the United States Marine 
Hospital Service the same year, in which he has 
served ever since, mainly in sanitary work, espe- 
cially in connection with yellow fever. On June 
1. 1910, his Ahna Plater bestowed on him the 
degree of Doctor of Laws. 

This honorary degree was bestowed for reasons 
that will be set forth in the following. 

The work on which he looks back with most 
satisfaction is : 

I. The establishment in quarantine practice of 
the correct relation between the disinfection 
(fumigation) of vessels and the detention of their 
personnel for yellow fever. 

In the Regulations of the L'nited States Gulf 
Quarantine Station of 1888, formulated by him, 
the detention of the personnel of the vessel, to 
cover the period of incubation of yellow fever, 
was first dated from the completion of the disin- 
fection (fumigation by sulphur) of the vessel, 
their last chance of exposure and infection. 

At that time the ports of the United States 
which required fumigation of vessels for yellow 

fever dated the period of detention " days 

from date of arrival in quarantine," or "from date 
of departure from last infected port," the number 
of days varying from "three" to "forty" or "to 
after frost." But in no case did this period bear 
any relation to the date of freeing the vessel from 
infection. It not infrequently happened, then. 



THE HOSPITAL BULLETIN 



that a vessel would lie Iter full time — say 20 da}s 
— in c[uarantinc and be freed from infection 
( fumigated) only the day of leaving. Some 
members of the erew exjiosed to infection just 
preceding or during this process in the hold or 
other seldom-visited parts of the ship would con- 
tract yellow fever and develop it after the vessel 
had docked and they had gone ashore, the period 
of incubation — five or six days — from the time 
the fever was contracted being sufficient to allij\v 
of this. 

This principle is entirely obvious and is the 
pivot of the whole system of combined disinfec- 
tion and detention, yet it was ignored not only by 
L'nitcd States ports, but in all the British ports 
considered infectable by yellow fever — Gibraltar, 
;\Ialta, Jamaica, Trinidad, ct a/.^as well as the 
I'rench and Danish West Indies, and it was not 
until the L'nited States Quarantine Regulations 
became mandatory that it became universal in the 
United States. 

II. Devising a system of maritime quarantine 
by which such sanitary measures, prevention of 
infection or disinfection, are taken for vessels in 
a foreign infected port as will enable them to sail 
free from infection for the United States from 
such ports, these measures being rendered pos- 
sible by corresponding privileges granted at the 
port of entry to the vessels which adopt them. 

This was begun in principle in 1890 and ap- 
plied extensively in 1893 at the cholera-infected 
ports of Europe. It is now an integral part of 
Maritime Quarantine System of the L'nited States, 
and has been of great value both as a purely sani- 
tary measure and as removing restrictions to com- 
merce, especially the last. 

III. W^'ork on the epidemiology^ of yellow 
fever, including the determination of its period 
of incubation in man, and especially the discovery 
of the "extrinsic incubation" of that disease. 

Dr. Henry R. Carter showed that while the ex- 
istence of a case of yellow fever in an infectable 
environment can render that environment in- 
iect-cd in a very short time, a few hours, yet a 
considerable period of time must elapse before 
that environment becomes infect-;V^ — that is, 
capable of communicating yellow fever to other 
men. This Dr. Carter called the "extrinsic incu- 
bation of yellow fever," and fixed its period at 
"somewhat over 10 days as a minimum." This is 
in close analogy with the time as determined by 
Celli and others that elapses between the date of 



an anoi)hfles mosquito Incoming infected with the 
parasite of malaria and becoming capable of con- 
veying that disease. This fact was used with 
much advantage in epidemiological work in 1898 
and 1899. The genius of Reed, James Carroll 
and Lazear (it was Lazear who first spoke to Dr. 
Carter of its implying a living host) used this 
thesis as a clue to the problem of the convevance 
of yellow fever. It is this that gives it its especial 
importance, and it is no small gratification to Dr. 
Carter to think that his work assisted in the epoch- 
making discovery of Carroll and Reed. 

I\'. In addition to the above permanent work 
of enduring excellence, presumablv we should call 
attention to Dr. Carter's work in the yellow-fever 
epidemics of 1893, 1897, 1898 and 1899, the de- 
tails of which are on record in the United States 
Public Health and Marine Hospital Service. In 
these epidemics he represented the L'nited States ; 
in Louisiana only in 1897; m the entire infected 
area in 1898 and 1899. This was purely execu- 
tive work, and was done with practically no au- 
thority, "in co-operation with State and local 
health authorities." Yet it was adjudged to have 
been successful. In his districts commerce was 
carried on fairly well, panic was quieted, and there 
was no spread of fever to new sections. In 1898, 
working with the JNIississippi health authorities, 
the epidemic of yellow fever at McHenry, a town 
in Southern jMississippi, was suppressed. This 
was the first instance of an epidemic of yellow 
fever in the far South, well under way, in June 
and July, being suppressed. 

The method used was the control of the human 
host. The conve}'ance by the stegomyia was ;wi 
then known, and, except the unnecessary disinfec- 
tion of clothing, was not all adapted to that end, 
even in the modern light of the mosc^uito convey- 
ance. The same methods here instituted were 
used successfully by White and Von Ezdorf in an 
outbreak of yellow fever at Hampton, Va., two 
years later. 

We have contrasted this executive work with 
permanent original or research work. This class 
of executive work bears the same relation to, say. 
the determination of the extrinsic incubation of 
yellow fever that a campaign, the troops using 
firearms, does to the discovery of gunpowder. 
The strategist avails himself of what the investi- 
gator discovers. 



THE HOSPITAL BULLETIN 



As an estimate of the value of Dr. Carter's 
work the following letters are appended : 

Board of Health Laboratory, 
Ancon, Canal Zone, October 4, 1900. 
Dr. ^^■illiam Royal Stokes, 

City Hall Annex, 

Baltimore, ]\Id. 
Dear Dr. Stokes : 

Before I forget it again I must write to you 
about a matter that has been on my mind for sev- 
eral months. Dr. H. R. Carter, who was our first 
Chief Quarantine Officer, and for four and one- 
half years Director of Hospitals here, has returned 
to the States, to be located at Louisville. Ky. 

Dr. Carter, as you know, by his wonderfully 
keen observations made during several epidemics 
of yellow fever, particularly the one in Louisiana, 
brought out his theory of an "extrinsic period of 
incubation," \\hich was of the greatest value in 
helping Reed to a successful issue in his A'ellow- 
fever experiments. 

Ronald Ross told iiic in Liverpool three years 
fl.^o that he had put in Dr. Carter'.; name for the 
Nobel prize. Dr. Carter has never received (|uite 
the recognition he deserves for his yellow-fever 
observations and for his pioneer quarantine work. 

As you and he are alunmi of the University of 
]\Iaryland. I want to suggest that you use your 
' influence in getting an honorary degree from the 
University for him next year. I cannot see why 
he has been neglected, for his work is recognized 
abroad and in all literature on the subject, and his 
name will alwa^'s be linked with Finlay's in con- 
nection with yellow fever. 

Reed in letters to Dr. Carter told him how val- 
uable Dr. Carter's observations had been to him 
in his }-ellow-fever work. 

I sent some slides showing malarial zygotes 
and sporozotes to Dr. Pearce of Winnipeg, and 
hope thev were of some value to him. 

\\"ith kindest regards to i\Irs. Stokes and the 
children, I am. 

Yours very truly, 

S. T. Darling. 

I have also made the suggestion to Dr. Perry, 
our jiresent quarantine officer, about the honorary 
degree for Dr. Carter. 

Board of Health Laboratory, 
Ancon, Canal Zone, December i, 1909. 
Dr. ^^'illianl Royal Stokes, 

City Hall Annex, 

Baltimore, Md. 
Dear Dr. Stokes : 

I have received from the members of Dr. Car- 
ter's family data relating to his work, investiga- 
tions and published researches in compliance with 
your request of October 14. 

1st, Tlie determination of the period of incu- 
bation of ycllozv fever: 

The determination of the period of incubation 



of yellow fever in man and the placing of the 
period of quarantine detention of the personnel 
for this disease on a rational basis, dating it from 
their last exposure. The completion of disinfec- 
tion to cover the period of incubation, while all 
ports of the United States and Great Britain were 
dating it from the hour of arrival in quarantine 
to leaving the infected port, the period of this 
detention being apparently chosen arbitrarily, as 
no two ports had the same. The disinfection of 
vessels on leaving ports infected with yellow fever 
and dating the time of detention from this disin- 
fection so that the days en route would count as 
days in quarantine. This, of course, he applied to 
all vessels leaving ports wdiere quarantinable dis- 
eases carried by vessels prevailed. 

2d. The discovery that there zvas a period of 
"E.vtrinsic Incubation" in its environment for yel- 
low fever and the approximate determination of 
its minimum duration as somewhat over 10 days: 

By "extrinsic incubation" was meant that a cer- 
tain considerable period of time must elapse be- 
tween the date that a place received infection from 
a yellow-fever patient before it became infective, 
i. e., capable of conveying it to other men. These 
investigations were begun in 1888. The article 
was written in December, 1899, and January, 
1900, and published in May, 1900. He himself, 
however, had lieen using it as a working basis 
for several years before — no one else accepting it. 

3d. Quarantine ivork at Chandeleur and Ship 
Island (';ri888 to 1892: 

^^'hat was really done at Ship Island and Chan- 
deleur was the establishment of the United States 
Maritime Quarantine System and the systematiza- 
tion of the quarantine methods for yellow fever. 
Prior to this time the State quarantine stations of 
the South Atlantic and Gulf ports differed among 
themselves in regulations, methods of disinfection 
and period of incubation, and no one station was 
willing to take the pratique of the other. His 
effort at Ship Island was to get them all to agree 
upon one method of handling vessels, doing all 
that was necessary and nothing that was believed 
to be unnecessary. . That was successful, and be- 
fore he left the Southern ports accepted the pra- 
tique of the United States stations. 

It was while here that he formulated his ideas 
of disinfecting vessels at the port of departure so 
that the days en route should count as days in 
quarantine. This was proposed at the meeting of 
the American Public Health Association at 
Charleston, S. C, in 1890. It was regarded as 
impracticable by some and dangerous by others, 
but is now universally accepted by sanitarians and 
is the key to practically all the methods of the 
United States quarantine. Its benefits to com- 
merce can readily be imagined. It was also here, 
while working upon the problem of the incubation 
of yellow fever in man, that he discovered the 
phenomenon of the "extrinsic incubation" of that 
disease in infected places, which he subsequently 



THE HOSPITAL BULLETIN 



25 



worked out in t8o8. Prior to this time, however, 
he was sufficiently convinced of its truth to use 
it as a working- basis. 

Since leaving- Ship Island and Chandeleur he 
has held every quarantine station of the United 
States from Ship Island to Delaware Breakwater, 
and had much to do with founding and equipping- 
them. He had charge of the train inspection, 
communication and everything save measures in 
the city in the P)rnnswick epidemic of yellow fever 
in 1893. He was in charge of the measures in 
Louisiana and the train inspection in the epiden-iic 
of i8<-)7. He was in charge of the South in the 
epidemics of i8q8 and 1899. In 1898 he was in 
charge of the epidemic of yellow fever in the little 
town^of McHenry, Miss., which was, it is believed, 
the first place in the South in which an epidemic 
of yellow fever had ever been stamped out in the 
sunmier time. He organized and had charge of 
the quarantine of the Island of Cuba in 1899-1900. 

SOME OF PUS PUBLISHED RESEARCHES. 

1st. ".\ Note on the Interval Between In- 
fecting and Secondary Cases of Yellow Fever 
from the Records of Yellow Fever at Orwood and 
Taylor, Miss., 1898." — The New Orleans Medical 
and Surgical Journal, May, 1900. 

2d. "A Note on the Spread of Yellow Fever 
in Houses — the 'Extrinsic Incubation.' " — Med- 
ical Record. June 15, 1901. 

This was written for the medical convention 
that met at Havana February, 1901. 

3d. "A Correlation of Some Facts in the prop- 
agation of Yellow Fever, with the Theory of Its 
Conveyance by the Culex fasciatus." — Philadel- 
phia Medical Journal, April 6, 1901. 

This was written while he was sick in hospital 
in Jjaltimore in November, 1900. 

4th. "Are Vessels Infected with Yellow 
Fever? Some Personal Observations." — Med- 
ical Record. March 22. 1902. 

5th. "Some Characteristics of the Stcgoinyia 
fasciatus which Afifect Its Conveyance of Yellow 
Fever." — Medical Record, May 14, 1904. 

6th. "The Conveyance of Yellow Fever." — 
Medical Xezvs, November 5, 1904. 

Reatl before the Texas State Medical Associa- 
tion April 27, 1904. 

7th. A little memorandum written April 6, 
1906 : published in the Medical Record — date not 
known — aiming to show that yellow fever was 
habitually contracted in the daytime, at least in 
Panama, in contravention of the statement of 
]\Iarchanx, Simon and Salimbini. 

Besides this, there have been a number of ar- 
ticles written for publication by the service, giving 
in detail the measures necessary in handling yel- 
low-fever epidemics — i. e., train inspection, com- 
munications with a town infected with yellow 
fever, etc. There have been, also, articles on 
other professional subjects, the first one in 1882, 
entitled "Syphilis in the Negro." 



RECENT TAPERS. 

"Recent Advances in Tropical Medicine." Read 
before the Pan-.\merican Scientific Congress held 
at Santiago, Chili, December 25, 1908, to January 
5, 1909. 

"Malarial Fever Work on the Isthmus." Reld 
before the Canal Zone Medical Association in 
1908. 

In 1905 or 1906 Dr. Carter's name was pre- 
sented for the Nobel prize in medicine. At that 
time he prepared a statement of his relations to 
the study of yellow fever as a sanitarian and an 
epidemiologist. The substance of Dr. Carter's 
statement is outlined above. There is no doubt 
that Dr. Carter's researches induced Durham and 
Walter Meyer to make the yellow-fever investiga- 
tion at Para, and that it actually influenced (and 
as to time determined ) the direction of Reed's 
investigations as well is borne out by many verbal 
and written statements by him. Dr. Reed had 
been much impressed by the valuable observations 
niade at Orwood and Taylor, Miss., by Dr. Carter 
on the interval between infecting and secondary 
cases of yellow fever. Experiments by Dr. Reed 
confirmed those already mentioned by Dr. Carter 
in 1898 that at least 12 days must elapse between 
contamination of the mosquito by the blood of a 
yellow-fever patient and the communication of 
the disease. Ronald Ross regarded Dr. Carter's 
observations on the extrinsic period of incubation 
of yellow fever as an extremely important one in 
its relation to the work of the Yellow Fever Com- 
n-iission in Cuba. Dr. Ross has recently invited 
Dr. Carter to contribute a chapter on his forth- 
coming book on tropical hygiene. 

The above memoranda expresses in bare out- 
lines Dr. Carter's work in connection with yellow 
fever, sanitation and quarantine. 

Ne-vy truly yours, 

S. T. Darlixg. 

Baltimore. Md. 
Dr. John C. Flemmeter : 

Dear Doctor — A number of the friends of Dr. 
H. R. Carter have thought for some time that it 
would be a deserving honor for him if liis .Alma 
Mater, the LIniversity of Maryland, could confer 
an honorary degree upon him on account of the 
early and important work which he carried out 
and which led directly to the brilliant discoveries 
of Reed and of his assistants concerning the trans- 
mission of yellow fever by the mosquito. I am 
informed by Dr. S. T. Darling, who has charge 
of the hygienic laboratory of the Canal Zone, that 
Dr. Carter has left the Isthnius and is about to 
settle in Louisville. Dr. Darling has very care- 
fully collected the data which we enclose, and I 
think that you will agree that this work is deserv- 
ing of proper recognition. On the other hand, it 
adds to the glory of our Alma Mater to empha- 
size such humanitarian work when performed by 
one of her son.s. We therefore respectfully ex- 



26 



THE HOSPITAL BULLETIN 



press the wish and hope that you will attempt to 
secure an honorary degree for Dr. Carter. 

The following is the data collected by Dr. Dar- 
ling concerning the work, investigations and pub- 
lished researches in compliance with your request 
of October 14: 

1st. The detcriuination of the period of incu- 
bation of ycllozv fever: 

The determination of the period of incubation 
of yellow fever in man and the placing of the 
period of quarantine detention of the personnel 
for this disease on a rational basis, dating it from 
their last exposure. The completion of disinfec- 
tion to cover the period of incubation, while all 
ports of the United States and Great Britain were 
dating it from the hour of arrival in quarantine 
to leaving the infected port, the period of this de- 
tention being apparently chosen arbitrarily, as no 
two ports have the same. The disinfection of 
vessels on leaving ports infected with yellow fever 
and dating the time of detention from this disin- 
fection so that the days en route would count as 
days in quarantine. This, of course, he applied 
to all vessels leaving ports where quarantinable 
diseases carried by vessels prevailed. 

2d. The discovery that there zvas a period of 
"Extrinsic Incnhation" in its environnicnt for yel- 
low fever and tlie approximate determination of 
its minimum duration as somezvhat over 10 days: 

By "extrinsic incubation" was meant that a cer- 
tain considerable period of time must elapse be- 
tween the date that a place received infection from 
a yellow-fever patient before it became infective, 
i. e., capable of conveying it to other men. These 
investigations were begun in 1888. The article 
was written in December, 1899, and January, 
1900, and published in May, 1900. He himself, 
however, has been using it as a working basis for 
several years before — no one else accepting it. 

3d. Quarantine work at Chandeleur and Ship 
Island t;ri888 to 1892: 

What was really done at Ship Island and Chan- 
deleur was the establishment of the United States 
Maritime Quarantine System and the systematiza- 
tion of the quarantine methods for yellow fever. 
Prior to this time the State quarantine stations of 
the South Atlantic and Gulf ports differed among 
themselves in regulations, methods of disinfection 
and period of incubation, and no one station was 
willing to take the pratique of the other. His ef- 
fort at Ship Island was to get them all to agree 
upon one method of handling vessels, doing all 
that was necessary and nothing that was believed 
to be unnecessary. That was successful, and be- 
fore he left the Southern ports accepted the pra- 
tique of the United States stations. 

It was while here that he formulated his idea 
of disinfecting vessels at the port of departure 
so that the days en route should count as days in 
quarantine. This was proposed at the meeting of 
the American Public Health Association at 
Charleston, S. C, in 1890. It was regarded as 



impracticable by some and as dangerous by oth- 
ers, but is now universally accepted by sanitarians 
and is the key to practically all the methods of the 
L^nited States Quarantine. Its benefits to com- 
merce can readily be imagined. It was also here, 
while working upon the problem of the incubation 
of yellow fever in man, that he discovered the 
phenomenon of the "extrinsic incubation" of that 
disease in infected places, which he subsequently 
worked out in 1898. Prior to this time, however, 
he was sufficiently convinced of its truth to use 
as a working basis. Since leaving Ship Island 
and Chandeleur he has held every quarantine sta- 
tion of the United States from Ship Island to 
Delaware Breakwater, and had much to do with 
founding and equipping them. He had charge of 
the train inspection, communication and every- 
thing save measures in the city in the Brunswick 
epidemic of yellow fever in 1893. He was in 
charge of measures in Louisiana and the train in- 
spection in the epidemic in 1897. He was in 
charge of the South in the epidemics of 1898 and 
1899. In 1898 he was in charge of the epidemic 
of yellow fever in the little town of McHenry, 
Miss., which was, it is believed, the first place in 
the South in which an epidemic of yellow fever 
had ever been stamped out in the summer time. 
He organized and had charge of the quarantine 
of the Island of Cuba in 1899-1900. 

SOME OF HIS PUBLISHED RESE.\RCHES. 

1st. "A Note on the Interval Between Infect- 
ing and Secondary Cases of Yellow Fever from 
the Records of Yellow Fever at Orwood and Tay- 
lor, Miss., 1898." — The New Orleans Medical 
and Surgical Journal, May, 1900. 

2d. "A Note on the Spread of Yellow Fever 
in Houses — the 'Extrinsic Incubation.' " — Med- 
ical Record, June 15, 1901. 

This was written for the ]\Iedical convention 
that met at Havana February, 1901. 

3d. "A Correlation of Some Facts in the Prop- 
agation of Yellow Fever, with the Theory of Its 
Conveyance by the Culex fasciatus.'' — Philadel- 
phia Medical journal, April 6, 1901. 

This was written while he was sick in hospital 
in Baltimore November, 1900. 

4th. "Are Vessels Infected with Yellow Fever? 
Some Personal Observations."- — Medical Record, 
March 22, 1902. 

5th. "Some Characteristics of the Stegomyia 
fasciatus which Effect Its Conveyance of Yellow 
Fever." — Medical Record, May 14, 1904. 

6th. "Conveyance of Yellow Fever." — Med- 
ical A'ezvs, November 5, 1904. 

Read before the Te.xas State IMedical Associa- 
tion April 27, 1904. 

7th. A little memorandum written April 6, 
1906; published in the Medical Record, date not 
known, aiming to show that yellow fever was 
habitually contracted in the daytime, at least in 
Panama, in contravention of the statement of 
Marchan.x, Simon and Salimbini. 



THE HOSPITAL BULLETIN 



V 



Besides this, there have been a number of ar- 
ticles written for publication by the service, giving- 
in detail the measures necessary in handling yel- 
low-fever epidemics — i. c, train inspection, com- 
munications with a town infected with yellow 
fever, etc. There have been, also, articles on other 
professional subjects, the first one in 1882, entitled 
■'S\'philis in the Negro." 

RECENT r.\PERS. 

"Recent .Vdvances in Tropical Medicine." Read 
before the Pan-American .Scientific Congress, held 
at Santiago, Chili, December 25, 1908, to January 
5, 1909. 

"Malarial Lever Work on the Isthmus." Read 
before the Canal Zone Medical Association, 1908. 

In 1905 or 1906 Dr. Carter's name was pre- 
sented for the Nobel prize in medicine. At that 
time he prepared a statement of his relations to 
the study of yellow fever as a sanitarian and epi- 
demiologist. The substance of Dr. Carter's state- 
ment is outlined above. There is no doubt that 
Dr. Carter's researches induced Durham and Wal- 
ter Meyer to make the yellow-fever investigation 
at Para, and that it actually influenced (and as to 
time determined) the direction of Reed's investi- 
gations, as will be borne out by many verbal and 
written statements by him. Dr. Reed had been 
impressed by the valuable observations made at 
Orwood and Taylor, Miss., by Dr. Carter on the 
interval between infecting and secondary cases 
of yellow fever. Experiments by Dr. Reed con- 
firmed those already mentioned by Dr. Carter in 
1898 that at least 12 da}-s must elapse between the 
contamination of the mosquito by the blood of the 
yellow-fever patient and the communication of 
the disease. Ronald Ross regarded Dr. Carter's 
observation on the extrinsic period of incubation 
of yellow fever as an extremely important one in 
its relation to the work of the Yellow Fever Com- 
mission in Cuba. Dr. Ross has recently invited 
Dr. Carter to contribute a chapter on his forth- 
coming book on tropical h3'giene. 

The above memoranda expresses in bare out- 
lines Dr. Carter's work in connection with yellow 
fever, sanitation and quarantine. 
Yours very truly, 

William Royal Stokes. 

coxclusiox. 

We have now reached a sufficient degree 01 
familiarity with Carter's work and the method of 
his research and thinking to recognize that he 
belongs to Goethe's "Auschaiicnden." He is 
clearly an objective worker who seeks to avoid 
imagination as far as possible, and humbly sub- 
mits to the hard facts of observation and experi- 
ment. 

The day will come when some great thinker — 
a medical Bancroft — will write the history of 
American medicine, and then such pioneers and 



heroes as James Carroll and Henry R. Carter 
will stand out on the roll of honor in the American 
}kledical "IValhalla" as brilliant as the names of 
any scientists, artists, statesmen, naval or military 
heroes our nation has ever produced. And this 
is to let the world know that they are sons of 
the University of Maryland. 



A CASE OF PERSISTENT VOMITING FOL- 
LOWING GASTRO - ENTEROSTOMY, 
PERFORMED FIVE YEARS AGO — 
SECOND ABDOMINAL SECTION, DE- 
CEMBER, 1910— CHEMIC AND PHYS- 
IOLOGIC STUDY OF DISTURBED CO- 
ORDINATION BETWEEN THE STOAI- 
ACH AND DUODENUM. 



Reported and shozvn by 

Albert II. Carroll, M.D. ; E. E. tKicnOLS, Senior 
Medical Student, and W. C. Marett, Senior 
Medieal Stndent in Prof. John C. Hemme- 
ter's Clinic on Diseases of Digestion and 
Mctalbolisni, University of Maryland. 



This interesting case which we have to present 
today is one of those obstinate cases of vomiting, 
with quantities of bile in the vomita, with emacia- 
tion, anemia and with marked nervous symptoms. 
An atrophic pancreatic condition was at first sus- 
pected and carefully looked for. The findings 
were negative. 

We are now convinced that this is a case of what 
is commonly called "vicious circle," following a 
gastro-entorostoniA-. This operation was done five 
>ears ago. It appears to us that relief will only be 
had by undoing the work then done, and this has 
been recommended. 

Entrance note. History. 

Name, C. E. : age, 30 years ; occupation, fireman 
on steamship of Hamburg-American line ; social 
condition, single. 

The patient entered this hospital December 5, 
1910, complaining of stomach trouble. He first 
had trouble with his stomach eight years ago, when 
lie had severe fullness and "hardness" after eat- 
ing, with frequent vomiting. He was treated for 
two years; his stomach was washed out every 
night. Six years ago — two years after his trouble 
began — he was operated on in Hamburg, Ger- 
many, by Professor Urban. At that time a gastro- 
enterostomy was done. Fourteen days ago he no- 
ticed a sensation of burning and heaviness in the 



28 



THE HOSPITAL BULLETIN 



epigastric region, coming on about one hour after 
taking food. This was reheved either by vomiting 
(which was frequent) or disappeared in about two 
hours. For the first six or seven days he kept on 
working, but since then he has been confined to 
bed. 

The vomitus is "lime-green" in color. Before 
this operation was performed the patient "vomited 
blood" twice. His appetite is poor; the bowels 
are regular. The first six days' stools were black 
and tar-like. Xo history of jaundice. 

Examination for occult blood was not made till 
later, and was not found then. 

Hub'/s. — Patient worked five years in a brewery 
in Germany, during which time he drank beer in 
large quantities. A history of other dietary indis- 
cretions or of trauma at any time was not ob- 
tained. We must remember that he is a stoker. 

Faiiiilv History. — Father died in 1880 in Aus- 
tralia. JMother living and well ; one sister and one 
brother living and well. Negative to cancer, tu- 
berculosis, gout, epilepsy, etc. 

Past History.- — Negative to diphtheria, tubercu- 
losis, measles, scarlet fever, rheumatism, pneu- 
monia and pleurisy. Had typhoid lasting six 
weeks while in Argentina, S. A., two years ago. 
He had an attack of gonorrhea at the age of 20 
years which lasted nine months, and again at 28 
years of age. which lasted five weeks. Past his- 
tory otherwise negati'V'e, except such troubles as 
above described. 

Present Illness. — ^^'hile at work about two 
weeks ago he was taken with pains of a dragging, 
dull character in his epigastrium, followed by 
sour eructations of a burning character and by 
vomiting. He says that the vomitus was largely 
composed of mucus of a whitish-gray color. Since 
then he has had numerous cramps — like attacks 
which were followed by the vomiting of a green- 
isli substance. Owing to poor digestion and as- 
similation, he is weak and has lost weight. He is 
very downcast and discouraged. 

Plivsical E.vaniination. — The patient is a fairly 
well-developed white man. with muscles of fair 
tone. The head is round, and is covered with a 
good crop of light hair. Forehead receding: no 
scars. Ears, no tophi, mastoid tenderness or dis- 
charge. Nose, no discharge or tenderness over 
accessorv sinuses. Eyes, pupils equal and react to 
light and accommodation, conjunctiva somewhat 
injected, .sclera clear, ocular movement good. 
Mouth, teeth in bad state of preservation, pyor- 



rhea marked. Tongue protrudes in the median 
line, slight tremor. Dorsum fairly clear, breath 
foul. No tonsillar enlargement. Neck well de- 
veloped, post-cervical glands palpable. No ab- 
normal pulsations or tracheal tug. Thyroid gland 
not palpable. 

Chest. — Fairly well developed, palpation and 
percussion normal and equal. Auscultation, voice 
sounds are decreased on the left side. 

Heart. — P. M. I. neither visible nor palpable. 
Sounds at apex beat heard at fifth interspace, to 
the inner side of M. C. L., of good tone and qual- 
ity. No murmurs were heard ; absolute cardiac 
dullness is not increased. 

Abdomen. — Liver dullness begins at seventh 
rib, and ])alpab!e two fingers' breadth below cos- 
tal margin. A median post-operative scar is noted 
above the umbilicus ; it is about three inches in 
length. 

Stomach. — Extends to the umbilicus, and gur- 
gling sounds were heard on direct percussion, 
otherwise negative. Inguinal glands palpable. 

Genitalia. — Large, bilateral varicocele. No scar. 

Extremities. — Poorly developed. His reflexes 
are normal. The axillary and epitrochlear glands 
are palpable. Pulse regular, tension and volume 
fair, and rhythm good. 

This case was referred from the medical to the 
surgical side, and an exploratory laparotomy ad- 
vised. The abdomen was opened by Dr. J. Holmes 
Smith, and it was found that a gastro-enterostomy 
had been performed. The stomach was opened, 
and both the pyloric and the artificial openmg 
found patent. No evidence of a past or present 
ulcer was present, or at least not observed. A 
large intestinal loop had been used. No obstruc- 
tion was found, and the openings in the stomach 
and in the abdomen were closed in the usual way. 

The patient's condition at first led us to suspect 
an atrophic pancreatis. (Later findings negate 
this diagnosis.) 

It has been noted that gastro-enterostomies are 
frequently followed by an atrophy of the pan- 
creas. (The normal stimulation of the pancreas 
is due in part to ihe action of the acid gastric con- 
tents on the papilla of Vater. This is supposed 
to send a reflex stimulation to the pancreas and 
excite it to action.) 

There are but few physical symptoms or signs 
by which a positive diagnosis of atrophy of the 
pancreas can be made. The pancreas is not nor- 
mally a palpable organ. Small cubes of boiled 



Till': HOSPITAL BULLETIN 



29 



meat enclosed in gauze were fed to this patient. 
The niicleii were not found in the muscle fibers 
when the gauze bags were examined after they 
had passed through the alimentary tract. Pan- 
creatis is associated with a great deal of weakness, 
emaciation and epigastric pain. Stools did not 
contain fat in excess after a- diet of olive oil and 
milk. 

Uriiw. — Color, amber ; odor, aromatic. Reac- 
tion acid. spgr. 1020. Albumen and sugar, ab- 
sent; sediment.' few epithelial cells and some 
granular. 

Stoiiiacli Contents. — On December 7 the patient 
vomited, and vomitus showed bile present in large 
amount. Free HCl 8. Total acidity 20. Xo 
blood. On December 8, after a test meal, the 
stomach contents were drawn, and consisted of 
aljout one pint of greenish fluid, with a fine brown- 
ish sediment. Free HCl absent Total acidity 
36. -Again no blood was found. Lactic acid test 
was negative. Microscopical examination — yeast 
cells, muscle fibers, cellulose and fat present, bile 
present. Blood, leucocytes 12,600, reds 3,500,000. 
Medicinal Treatment. — Had a pancreatitis really 
complicated this case of "vicious circle," we might 
have given artificial preparations of the pancreas, 
pancreatin or papain to replace the pancreatic fer- 
ments. However, we doubt the presence of an 
atrophic pancreatis, basing our diagnosis on the 
microscopical examination of the feces after a fat 
plus a meat diet. 

His measurements are as follows : 

M. X., 8 inches. 
M. U., 16 inches. 
-M. S., 8K' inches. 
X. R. S., 9 inches. 
X. L. S., 9 inches. 
S. S., 9 inches. 
C. at X., 34 inches. 
A. at X., 90°. 
Height, 5X> feet. 
X angle, 90°. 
Weight, 125 pounds. 
Age, 30 years. 
Present clinical findijigs: 
Hemoglobin, 70°. 

Urine, negative to albumen and sugar. 
Feces, no starch or an excess of fat. 
Stomach contents, no free HCl; total acidity, 
30; no blood. 

Sputum negative to T. B. 



No gastrojjtosis, and onh- a slight dilation of 
the stomach. 

No floating tenth ribs. 

No occult blood found. 

Trcotnwnt. — This is surgical. The gastro-en- 
terostomy should be undone and the opening 
between stomach and duodenum should be closed. 
The food will then pass through the pylorus into 
the duodenum, and thereby restore che norma! 
stimulus to the pancreas. -Although there was a 
deficiency of HCl, an undiscovered ulcer is to be 
thought of, and the return flow of alkaline in- 
testinal secretions may ha\'e neutralized any 
hyperacidity. 

The prognosis is not favorable. 

The patient has returned to German)'. 



CARCINOMA OF SCALP.* 



By .A. -Aldridge Matthews, ]\I.D., 
Spokane^ Wash. 



Case VIII. — A. K., schoolboy; age 14. Re- 
ferred to me October 24, 1910. 

Past and family history negative. In February 
of this year he was struck on the head with a 
dress-suit case, the corner of which lacerated his 
head in the post-parietal region on the left side. 
He went to a physician, who cleaned the wound 
and sewed it up. The wound healed by first inten- 
tion and seemed to be practically well, but about 
two months later he noticed a small swelling about 
the size of a bean, which he thought was a wart 
starting on his head. He went back to his phy- 
sician, who excised a little growth, and told him 
that it would give him no more trouble. -A little 
later, after the wound had healed, he noticed that 
the growth was coming back, and he let it grow 
until it reached the size of half a hen's egg, as he 
e-xpressed it. At this time he went to another 
physician, who removed this growth again and 
sutured the wound together, which healed pri- 
marily, this being only six weeks ago. Since this 
time the growth has increased very rapidlv in size 
and is now the size you see it. about three inches 
in diameter and one inch in thickness. It occupies 
the post-parietal and occipital region on the left 
side. It is very hard and firm to the touch, and 
painless. 

The glands down the neck are palpable, the 
largest being about the size of the end of your 

•Repoi'ted af Spokane County llcilioal Socii't.v. 



30 



THE HOSPITAL BULLETIN 



finger. I removed one of tliese glands and had it 
examined, and found it to be a carcinoma. This, 
I must say, I felt skeptical about. From the clin- 
ical history I made my diagnosis a sarcoma, but 
the involving of these glands made it puzzling. 

A day or two after my examination I operated 
upon this boy, removing a large area of scalp 
around the growth, also removing the periosteum, 
and had contemplated removing the bone, but 
upon removing the periosteum I found that there 
was no apparent direct connection between the 




C.\SE 



.\. K. 



.\liovp picture represents about thrce-quiirtors of the orisin.il 
size of growth and a Tcrtieal scar from a previous operation 
and stitch-holc scars on the sides. 



gi'owth and the bone, except that it was a little 
more adherent in the area where I think he re- 
ceived the original blow, and from that area I 
removed a piece of bone about the size of a half 
dollar, although there is a question in my mind 
whether it was involved. I also made a dissection 
of the glands of the neck. 

In closing the incision I had to slip flaps fiom 
three directions, covering over the area of the 
bone from which T had removed the periosteum. 



These flaps were composed of the scalp, but did 
not disturb the periosteum under them, simply 
using the flaps alone to cover the bone. The 
wound healed up primarily, and on the eighth day 
following the operation I grafted skin on the peri- 
osteum, from which I had removed my sliding 
flaps. I would have done this at the time of the 
operation, but there was so much capillary oozing 
that I was certain the grafts would not take. The 
grafts I got from his thigh. 

The young man up to the present time has been 
perfectly well and no indication of any recur- 
rence. This specimen is the growth which I re- 
moved, but is very much shrunken from the pre- 
servative solution it has been kept in. Sections 
made from the growth proved the diagnosis to be 
carcinoma. 



REPORT OF 



A CASE OF S.VRCOMA OF 

TIBIA.* 



By A. Aldridge M.vttiiews, M.D., 
Spokane. JJ'asIi. 

Case XII. — N. M. L., schoolgirl; age 15. 

I was called in consultation to see above patient 
with Dr. J. F. Hall of Spokane. Family history 
negative. Past history negative. Present trouble 
dates back about nine months, and at this tiine she 
claims that her little sister kicked her on the upper 
third and anterior surface of right tibia. She 
thought nothing of it at the time, but it remained 
sore all the time upon pressure, and also com- 
plained that after using her leg she felt a little 
soreness in that region. About three months ago 
a small swelling appeared over this area which 
had been tender for so long, which was quite hard 
to the feel and gave her pain upon pressure. 

^\bout six months after receiving the injury 
she went to see a physician, who told her that he 
thought there was possibly some pus in this area 
and suggested opening it, but she declined, and 
after letting it go for some time went to see 
another physician, this being about six weeks ago, 
who advised opening down upon this small swell- 
ing, as he thought there was some pus present. 
This was done with local anesthesia, but after so 
doing he advised her that he could do nothing 
without putting her to sleep and scraping it out. 

At pixscnt the growth presents a large red 
swelling of the iiuier upper third of the tibia; 



*I!eported at Spoliane Counl.v Jleiiical Society. 



THE HOSPITAL BULLETIN 



31 



hard, quite sensitive to pressure, and now causes 
her considerable trouble when she walks. This 
discomfort in walking is gradually getting worse. 
The incision, which was done six weeks ago, had 
perfectly healed, but the growth had increased 
considerable in size in that time. 

I agreed with Dr. Hall in his diagnosis as this 
being an osteosarcoma, and advised immediate 
amputation. On the next day, the 28th of No- 
vember, I operated. Before amputating I opened 
down upon the growth, and felt convinced with- 



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CASE 12. il. jr. L. 
Osteo-sarcoma of upper third of tibia. 

out a reasonable doubt that it was an osteosar- 
coma ; the variety I could not say positively, as I 
had no means at that time for making sections. 
I then amputated a short way above the condyles 
of the femur, this giving me ample flaps to cover 
the stump. The patient did perfectly well, but 
the flaps underwent a dry gangrene for no reason 
as far as I can see. The blood supply seemed to 
have been ample, although she bled very little at 
the time of amputation. 



There was no infection at any time in the 
wound, not even 10 days after the work was done, 
and about this time I placed the patient under an 
anesthetic, trimmed otT the dried back flaps, re- 
sected about two inches of the femur, "and drew 
my new flaps over, which healed primarily. 

This is my second experience in having flaps 
slough after amputating for sarcoma. I cannot 
give any reason why this should be, although I 
have had other men tell me that they have had the 
same experience. 

I placed this patient on Coley serum and gave 
her increased doses for six weeks following the 
amputation. The patient is well and in excellent 
condition at present date. 



TREATMENT OF PUERPERAL 
ECLAMPSIA.- 



By RoscoE D. McMillan, M.D., '10, 
Red Springs, N. C. 



In presenting this paper I ful-.y realize that I 
have chosen a subject whose very depths stand as 
}et unsounded, as we all know eclampsia is one 
of the most formidable accidents to which the 
pregnant woman is liable. This subject, like many 
other questions of medical interest, the older they 
are the more they are subjected to discussion and 
to criticism, the more interesting they become, 
especiallv in these late years when they can be 
approached and studied, and in some instances 
solved by scientific methods of investigation, yet 
this disease is still classed as "The Disease of The- 
ories." In order to treat any disease successfully, 
it is very necessary that the doctor have a thor- 
ough understanding of the cause or causes of the 
disease he is about to treat, but as yet we are abso- 
lutelv ignorant concerning the cause of this dread- 
ed maladv, but we know that there is a toxic sub- 
stance circulating in the blood which should have 
been, but has not been, eliminated by the various 
excretory organs. 

The treatment may be divided into two heads, 
namelv, prohpylactic and curative. 

First, Prophylaxis. — This, if instituted at the 
proper time, will prevent many cases of eclampsia, 
and is certainly productive of untold good, but is 
not always successful or applicable. It is a very 
unfortunate thing that the doctor rarely sees the 

•Read hefore FiftU District Medical Society of Xortli Caro- 
lina October 11. 1910, at Fayetteville, N. C. 



THE HOSPITAL BULLETIN 



case until he is called, and the woman is found in 
labor or in active convulsions. 

In every case where the doctor has the oppor- 
tunity he should forcibly impress his patient, as 
well as her husband, the paramount importance of 
the proper care of the pregnant woman ; a speci- 
men of urine should be sent to his office regularly 
twice a month for the first seven months, and 
once a week during the last two months of preg- 
nancy, and he should be promptly advised if any 
of the characteristic symptoms arise as disturbance 
of vision, continued headache, edema of face and 
limbs and scanty urine, ^^'here there is any reason 
at all to suspect trouble the physician should sec 
the patient himself and institute at once proper 
treatment. Restrict the diet principally to milk. 
with the addition of dry toast, fruits, chicken 
broths and the use of plenty of good drinking 
water. Avoid all stimulants, tea, coffee and meats. 
Keep the skin, liver and kidneys in active condi- 
tion. Watch }our patient closely for a few da\ s. 
and if she does not improve under this expectant 
treatment don't delay, but empty the uterus in the 
most conservative manner by the induction of 
premature labor. By the use of these precaution- 
ary measures the frequency of eclampsia will be 
greatly diminished, and many valuable lives saved. 

Curative. — When in the presence of actual con- 
vulsions, each and even,' case should be treated 
rationally, the treatment being determined upon 
and directed against the cause or causes as they 
present themselves in the individual case, but I 
strongly advise against the use of chloroform in 
the hope of cutting the convulsive seizures short. 
In this case morphia is the sheet anchor. Give 
a hypodermic of morphia grs. J4, combined with 
atrophia grs. 1-150 every 30 minutes until four or 
five doses are given. It is remarkable the immu- 
nity these patients seem to enjoy against the c\il 
effects of this drug. A folded towel should be 
placed between the patient's teeth to prevent bit- 
ing her tongue. Stimulate diuresis and bowel 
movements, and for this I know of nothing better 
than the old and time-honored drug powdered 
calomel given in large doses, 15 to 20 grains, on 
back of tongue. If the convulsions come on dur- 
ing pregnancy or labor, deliver your patient as 
soon as possible. As Williams says, "delivery 
should be effected as soon as is consistent with the 
safety of the patient," and I heartily agree with 
him. If the head is low down, deliver with for- 
ceps : if high, it is well to resort to internal podalic 



version. Of course, eidier should be done under 
profound anesthesia and rigid asepsis, and ether 
is the anesthetic of choice. Where the cervical 
canal is obliterated, or nearly so, the dilation can 
be completed by the Harris method of finger dila- 
tation, or with the aid of instrumental dilatation, 
using instruments with caution. If the canal has 
not been obliterated, and is very resistant, don't 
hesitate, but cut the cervix with blunt scissors and 
empty the uterus. 

After delivery of the child the eliminative or- 
gans should be encouraged as much as possible. 
If the bowels have not moved, give two drops of 
croton oil in one dram of olive oil on back of 
tongue. Surround patient with hot packs, blan- 
kets wrung in hot water, and surround with hot- 
water bottles. 

Diuresis and diaphoresis should be encouraged, 
and I strongly advise against the use of salt solu- 
tion and the hypodermic injection of pilocarpine. 
If there is excessive nervousness, give 30 grains 
of ciiloral and 30 grains of potassium bromide in a 
pint of hot water passed high into the rectum. 

In the class of cases with high arterial tension, 
the withdrawal of several ounces of blood from 
the arm or a lumbar puncture is sometimes at- 
tended with happy results. 

My experience with Veratrum "V'iridi in this 
class of cases is sufficient to condemn its use, espe- 
cially in private practice. 

A very important fact to remember is that in a 
great majority of cases the heart muscle is weak, 
and the treatment all along has been of a depress- 
ant nature ; the fact must not be lost sight of that 
stinnilation may be necessary. No treatment 
should ever be pushed to the point of endangering 
the patient's life from heart failure. 

In conclusion, will say the entire line of treat- 
ment can be summed up in one word, namely, 
elimination, and in every case where delivery has 
not been accomplished, it is well to hasten delivery 
by all practical means, as the condition of preg- 
nancv is the cause of causes. 



Dr. Rigdon Osmond Dees, class of 1906, is 
pursuing special work at the University. Dr. 
Dees and his brother, Ralph Erastus Dees, also 
of the class of 1906, are located at Greensboro, 
N. C., and enjoy extensive practices. 



THE HOSPITAL BULLETIN 3J 

■TLIC HO^PITAI Rlll I FTI N ^^^^^ have gone from our threshold each )-ear are 

also solicited to make contributions as classes, 

A Monthly Journal of Medicine and Surgery , , , • ,1 u r i i 

and, where it is possible, a member of each class 

PUBLISHED BY r ., ^ t ^ -ll 1 • . 1 . 

for the past forty years will be appointed to com- 

THE HOSPITAL BULLETIN COMPANY . / .,,,., , ,,•■..,■ 

„ municate with his classmates and solicit their co- 

608 Professional Building .... 01,, 

operation in this purpose, bome headway has 

Baltimore, Md. , , , , • , • ■ , 1 

already been made in this campaign, and several 

_ . . . . ^ . , alumni have promised substantial contributions. 

subscription price, . . . $1.00 per annum in advance „,%„,..,, 

„.,.,, A ', • • I he r acuity of Physic will devote the bequest of 

Reprints furnished at cost. Advertising rates . _ , . , . ,. , 

submitted upon request the late Miss Robinson to this fund. 

Robinson bequest $5000 

Nathan Winslow, M.D., Editor Class of 1873— Dr. T. A. Ashby. Dr. R. 

- Winslow 200 

B.\LTiMORE, Ma, April 15, 191 1. Class of 1882— Dr. J. M. Hundley 250 

Class of 1901 — Dr. Nathan Winslow 50 

Class of 1902 — Dr. A. M. Shiplev 2=50 

^ THE RANDOLPH WINSLOW SCHOLAR- ' L 

SHIP. S5750 

Another scholarship has been founded for the ABSTRACTS 
benetit of needy and worthy students of the Medi- 

-— cal Department of the University of Marvland. t^cttxt 

T^, • , r , , , . ■, ; , • DEFECTIVE CHILDREN, 
inis makes four scholarships now avanable m 

our school for this purpose: The Samuel Leon r)r. Watson Smith Rankin, class of 1901, in an 

Frank scholarships, endowed by the widow of the address before the North Carolina Teachers' As- 

lato Dr. Samuel Leon Frank; the two Flitchcock sembly, Asheville, N. C, June 17, 1910, has the 

scholarship, created through a bequest of the late following to say concerning adenoids in an article 

Dr. Charles M. Hitchcock of California, and the entitled "The Importance of the Recognition of 

Randolph Winslow scholarship, endowed by Prof. Physically Defective Children by the Teacher" 

Randolph Winslow. This bequest has been com- {BnUctin of the North Carolina Board of Health, 

pleted and becomes available next October. It is October, 1910) : 

not intended to assist idle and incompetent stu- "Adenoids.— Thty are composed of what we 

dents, but only those who are both needy and call lymphoid tissue, the principal function of 

worthy. It is open to students of the senior, which is to act as a filter or sieve to catch invading 

junior or sophomore classes who are of good germ- Its structure is admirably adapted to its 

character and who are in need of assistance to I""ction ; it consists of only two parts ; small, very 

continue their studies and who have maintained ^"^^" threads or fibers of tissue running in all di- 

an average grade of 85 per cent, in all their nre- sections and interlacing so as to form a structure 

- vious work. The scholarship is to be awarded bv '''^'^ nothing so much as a spider's web. In the 

the Trustees of the Endowment Fund upon the "^^^^'^^^ °^ this web is the second part, namely, mil- 

C nomination of the Facultv of Physic. ^'°"s of very small, round cells. Into this mesh- 
'_ work of fibers and cells a fluid which is known as 

THE ENDOWMENT OF THE DEPART- ^"""'P^' '' P^"'^"^' ^"'^ ^'"' '"'"'P'' '' ^''^ ^"''^ ^''^' 

, |._,^^ ^ „^.^ has exuded from the blood vessels into the tissues 

which it has nourished and is being returned to 

Elsewhere will be found an appeal from the the veins. However, in nourishing the tissues the 

committee on endowment to the alumni and others lymph takes up the waste products of the tissue 

for aid in raising $100,000 to place our patho- cells and any germs that happen to be in the tis- 

logical department upon a full time paid basis, sues. It is, therefore, important that before this 

This is the most urgent need of the medical fluid, the lymph, be poured into the veins, thence 

school at this time. The committee is working into the heart, and then sent to all parts of the 

upon this problem. The public will be asked to body, that it be filtered ; and so it is passed through 

help us in this matter, but the individual classes this lymphoid filter, where any germs it may carry 



34 



THE HOSPITAL BULLETIN 



are immeshed in tlie fibers and destroyed bv tlie 
little round cells. 

"Nature has wisely placed this filter tissue in 
those situations where filtration of the lymph is 
most needed ; that is, in those places where germs 
are most abundant and most likely to gain entrance 
into the tissues or flesh. Hence we find large accu- 
mulations of lymphoid masses, lymph glands, in 
the armpits, where they guard the body against 
the entrance of germs that get into the flesh of the 
upper extremity ; we find many of these lymph 
glands in the groins, guarding the body against 
infection from the lower extremity ; the intestine 
is fidl of germs, and the intestinal tube has an 
abundance of this filter tissue in its walls, and so, 
in proportion to the exposure of any localitv of the 
body to infection, do we find lymphoid tissue in 
varying amounts. Again, as the child has had less 
training in fighting germs than the adult, and is 
more prone to disease than the adult, less able to 
protect itself, so it needs relatively more of this 
lymphoid tissue than the adult, and it is a fact that 
lymphoid tissue is relatively more abundant under 
12 than after that age, when, not needed so much, 
it undergoes considerable shrinkage. 

"Now, of all places exposed to infection or 
germs, the tube through which we consume our 
gaseous food, the tube through which we breathe, 
is most exposed. Lailike the tube through which 
we take our liquid and solid food, it is in constant 
use. In breathing air of average purity we inhale 
about 25,000 germs per minute; most of those 
germs are, fortunately, harmless. Through this 
portal enter the germs causing tuberculosis, pneu- 
monia, scarlet fever, measles, whooping-cough and 
other diseases. Tuberculosis and pneumonia, the 
two greatest causes of death, kill 300,000 people a 
year, one-fifth of the entire death rate of the 
L'nited States. The most exposed portion of this 
most exposed tube is an angle in the tube just back 
of the nose, where the horizontal or nasal part of 
the tube joins the vertical or pharyngeal part of 
the tube. Now, dust and germs tend, by the laws 
of gravity, to lodge in this angle of the breathing 
tube. And Nature, following the rule of provid- 
ing most of this lymphoid or filter tissue where ex- 
posure is greatest, has abundantly supplied the 
roof of the throat which is at the back of the nose ; 
that is, the angle of the breathing tube, with this 
tissue, 

"\\'ith these two factors, a large amount of soft, 
spongy tissue and constant and comparatively se- 



vere exposure to irritation, we may be on our 
guard for trouble in the pharyngeal vault. As 
long as the lymphoid tissue can take care of the 
germs gaining entrance there is no trouble. But 
in about 10 per cent, of children this becomes im- 
possible, and these lymphoid masses swell. If the 
trouble is soon removed, the swelling subsides 
and no permanent damage results. On the other 
hand, should the irritation be unusual in amount 
or of long duration, a permanent enlargement, 
var\ing in size from a hazelnut to a hen's egg, re- 
sults ; and this is what we call adenoids. These 
enlarged masses of tissue are lobulated, soft, and 
feel to a finger pushed into the throat like a mass 
of earth worms, bleed very easily, and are covered 
over with a la}er of thick mucus which is often 
mixed with pus or matter. 

"The first efifect of this nasal obstruction, nat- 
urally, is to interfere with the breathing. The 
cliild is obliged to have air, and, being unable to 
get it through the nose, becomes a 'mouth 
breather.' If the postnasal obstruction is not too 
great, the child during waking hours will, by extra 
muscular effort and by keeping the nose and throat 
clear of mucus, be able to get in enough air 
through the nose ; but at night, when these volun- 
tary processes are in abeyance, the child uses both 
nose and mouth, and this means snoring. It 
means, as a rule, disturbed sleep, too. The small 
amount of oxygen gives to the subconscious mind 
an uneasv feeling, producing bad dreams which 
awaken the child with 'night terrors.' As the 
masses of adenoid tissue grow or become inflamed, 
mouth breathing becomes more and more a vital 
necessity, until the child breathes day and night 
through the open mouth. Now, with the nose par- 
tially or completely discarded as a respiratory tube, 
and the mouth having taken up this work, it be- 
comes necessary that the mouth cavity be enlarged. 
This enlargement takes place by the roof of the 
mouth bulging upward into the now useless nasal 
cavity. This bend having once started, the con- 
stant inward pressure of the strong muscles of 
mastication accentuates it, causing the high- 
vaulted jialate, the narrow dental arch with its 
forward protrusion and crowded teeth. These 
factors combined give us the characteristic adenoid 
expression ; the narrow face, the undeveloped, 
small nostrils, the short upper lip, the absence of 
normal lines about the mouth, the narrow nose, 
the drooping inner angle of the eyes, and the high- 
arched e\ebrows. 



THE HOSPITAL BULLETIN 



35 



"Tlie voice loses that quality given it by an open 
pharyngeal vault — resonance. The speech is 
stutty; F is substituted for T H, so that 'teeth' is 
pronounced 'teef ;' G is substituted for N G, so 
that 'song' is pronounced 'sogg;' B is substituted 
tor JNI, and D for N, so that 'common' is pro- 
nounced 'cobbed,' and 'nose' is pronounced 'dose.' 

■'Breathing is greatly interfered with, quantita- 
tively and qualitatively. The quantity of air ad- 
mitted is diminished in proportion to the amount of 
obstruction. If much diminished, there is a par- 
tial collapse of the spongy lung tissue. This leaves 
a vacuum in the chest and tlie chest walls ; the 
softer part of them along each side of the breast- 
lione become depressed, giving us the chest with 
the prominent breastbone or pigeon-breast. The 
quality of the inspired air is altered. Normally, 
the extensive, convoluted and turbinated nasal 
walls, giving a very extensive warm, moist sur- 
face, serve to warm the inspired air and to filter 
out on their sticky surfaces many of the germs. 
Xot so when nasal respiration is partially or com- 
pletely abolished. The air entering the lungs is 
colder, and, carrying more germs, it makes the 
adenoid victim very susceptible to cold, grip, pneu- 
monia, tuberculosis and other air-borne diseases. 

"Smell is to varying extents destroyed. The in- 
flamed and mucus and pus-covered adenoid tissue 
at the back of the nose grows forward into the un- 
used nasal cavity. The nasal mucous membrane 
liecomes chronically inflamed and covered with 
nnicus and pus. This means that smell, located in 
this membrane and dependent upon its healthy 
condition, is to varying degrees destroyed. You 
probably recall in this connection your own loss 
of this sense when you suffered from the ordinary 
nasal cold. Now, the sense of smell and taste are 
closely related ; the sense of taste is two-thirds de- 
pendent upon smell. In the brain the centers of 
smell and taste are next-door neighbors. Recall 
again the loss of taste in colds. Moreover, taste 
is an important adjunct to digestion. Appetite, 
the desire for food, is very dependent upon taste. 
Science has also demonstrated that the secretion 
of digestive juices in the stomach is due in part 
to reflex nervous influences originating in taste. 
Now, when taste is interfered with the appetite is 
poor, less food is taken, and on account of the de- 
crease in amount of digestive juice, what is taken 
is less well digested. Thus, adenoids interfere 
with the ingestion of a!! foods, gases to the lungs, 
liquids and solids to the stomach, and with the 



digestion of the solids and liquids. The result is 
a stunted growth and a decrease in the capacity 
for all kinds of work. '■' * * The number and 
distinctiveness of the symptoms vary with the 
duration and severity of the disease. 

"The mild cases sleep poorly, snore, and many 
of them have 'night terrors.' They are very sus- 
ceptible to colds and coughs ; many are physically 
and mentally stunted. 

"The medium cases have all the symptoms of 
mild cases accentuated, and mouth breathing is 
usually present during the day. The character- 
istic expression, already described, is now easily 
recognized. 

"The severe cases show all the symptoms de- 
scribed in connection with the disease in a pro- 
nounced and easilv recognizable form." 



ITEMS 



The following report was submitted to the 
Alumni Advisory Council at their last meeting, 
March 2^, 191 1, by Dr. E. F. Cordell, chairman 
Committee on Nomenclature : 

Having been requested to suggest a nomencla- 
ture for the buildings of the University, I present 
the following: St. John's being adequately pro- 
vided for in the designations — McDowell Hall, 
Humphreys Hall, Pinckney Hall, Woodward Hall, 
Senior or Mess Hall, Gymnasium, etc. — does not 
require consideration here. ■ I shall confine myself 
therefore to the professional schools of the Uni- 
versitv located in Baltimore. 

Although the custom of applying the names of 
eminent presidents, professors, alumni and bene- 
factors to different departments of universities has 
been adopted elsewhere and is growing in favor 
and practice, it has only recently been applied in 
this institution. I may say, however, without 
offense I hope, that the results have not been so 
far very satisfactorv. Perhaps the matter was 
not considered suflrciently. It seems exceedingly 
desirable that a systematic nomenclature should 
be adopted by the Regents. There are practical 
as well as sentimental reasons for its considera- 
tion and application that must appear convincing 
to anyone who gives the matter due thought. Wc 
are not called on as yet to honor in this way any 
great benefactor, so that our action must be dic- 
tated by sentiment. 

I. The Department of Medicine. There is one 
name that especially appeals to us in this depart- 



36 



THE HOSPITAL BULLETIN 



nieiit for recog'nition, and that is Jolin B. Davidge, 
the founder of the Medical School and the Uni- 
versity. To adequately honor him we should as- 
sociate his name with the main medical building- 
and call it "Davidge Hall." Professor Potter, 
also a founder and incumbent of the chair of prac- 
tice for 36 vears, certainly comes second, and the 
building- now known as "Davidge Hall" might 
receive his name. Practice Hall, to which the 
misnomer Gray Laboratories has been applied, 
might bear that of De Butts, the eloquent chemist 
(1809 to 1S31), since it contains the chemical 
laboratory, a department over which he presided 
with so much reputation and success. The pro- 
posed students' dormitory, on the northwest cor- 
ner of Greene and Lombard streets, might be 
called "Smith Hall," after the great surgeon, 
Nathan R. Smith. I would suggest that the name's 
"anatomical theater" and "chemical theater" be 
retained, since thev are so appropriate and have 
been sanctioned by such long usage. The labora- 
tories do not need any change, and may still be 
called "The Chemical Laboratory," "The Patho- 
logical Laboratory," "The Physiological Labora- 
tory," "The Cliuical Laboratory," and the same 
in the case with "The Dean's Office," "The Stu- 
dents' Room," "The Dissecting Room," "The 
Library" and "The Christian Association Room." 

In the Department of Law there are five names 
that especially appeal to us, viz., those of Chief 
Justice Tane}', John P. Kennedy and S. Teacklc 
Wallis, who were provosts and men of great emi- 
nence ; David Hoffman, the first professor of law 
and founder of the Law School, and John P. Poe, 
who was so long connected with the reorganized 
school as professor and dean. It seems eminently 
appropriate that we should select the greatest of 
these names to designate the law building, which 
would thus in future be known as "Taney Hall." 
There are but two lecture-rooms at this time, so 
that we are compelled to make a choice of tw(i 
of the others for these, and I would suggest that 
they be known henceforth as Wallis and Poe 
Rooms, respectively. I hope the day is not dis- 
tant when the other two names shall be commem- 
orated in some way, perhaps by professorships, 
scholarships, prizes or medals. 

In the Department of Dentistry the name of 
the Father of American Dentistry, Dr. Horace H. 
Hayden, who delivered in this University in 1837 
what was, so far as we know, the first scientific 
course of lectures given in .\nierica, suggests it- 



self, and it would be eminently appropriate that 
the dental building should receive the name "Hay- 
den Hall." The laboratories and infirmary need 
no change, but I suggest that the dental museum 
receive the name of "Gorgas Museum." in honor 
of the distinguished dean, to whose labors it is 
due. There should be some commemoration also 
of the late Prof. James H. Harris, who was asso- 
ciated with Professor Gorgas in the founding of 
the school and was famed as a skilful dentist, but 
the future must provide for this want. 

The Department of Pharmacy is not at present 
in need of a nomenclature, but when it gets a 
building, as it must soon do, to provide for its 
growing classes, the name of David Stewart, one 
of its founders and who enjoyed the distinction 
of being the first independent professor of phar- 
macy in America, could well be used to designate 
its "Hall." 

I have thus endeavored to fulfil the responsible 
duty which you imposed upon me at the last meet- 
ing. It will be seen that I have adopted the name 
"Hall" for the various buildings, and "Room" for 
the apartments of the same, following in this 
respect what I believe is the common usage. The 
laboratories suggest their own designations. 

All of which is respectfully submitted. 

Eugene F. Cordell, ;M.D.. 

Committee. 

March 21, 191 1. 



Dr. Reed A. Shankwiler, class of 1909, who 
was for some time a resident physician at Eudo- 
wood Sanitarium, Towson, Md., has been ap- 
pointed superintendent of the Detroit Tuberculo- 
sis Sanitarium, which has been recently erected 
in Detroit. Dr. Shankwiler is at present the 
guest of his mother at 3809 Park Heights avenue, 
Baltimore. He was until very recently connected 
with the Hazelwood .Sanitarium of Louisville. Kv. 



The imdersigned committee direct the follow- 
ing appeal to our alumni : 

Dear Sir — The Faculty of Physics, being firmly 
convinced that the scientific chairs of a medical 
school should be filled by scientists who give their 
whole time to the duties of their chairs, and not 
by practitioners of medicine, have appointed the 
subscribers a committee to devise means to bring 
about this important change in the School of 
Medicine of the University of Maryland. 

Wc therefore ask the aid of our alumni and 



THE HOSPITAL BULLETIN 



3? 



friends in raising the sum of $100,000 for the 
endowment of the Department of Pathology. 

Anv amount tliat you may feel able to con- 
tribute to this object will be gratefully received, 
as will also any suggestions or other assistance 
that may expedite our purpose. 

This fund will be administered by "The Trus- 
tees of the Endowment Fund of the University of 
IMarvland," an entirely independent corporation, 
not connected with the teaching faculties of the 
University. 

Subscriptions may be sent to any of the under- 
signed, and will be gratefully acknowledged in 
The Hospital Bulletin and in Old Maryland. 
A'ery truly yours, 

Randolph Winslow, 
John C. Hemmeter, 
Arthur M. Shipley. 



Dr. Robert H. Hargrove, class of 1877, is lo- 
cated at Kinston, N. C. 



Dr. T. A. Ashby, class of 1873, of Baltimore, 
has sold to Mr. Arthur L. Warthen, president of 
the Front Royal (Va.) National Bank, the place- 
known as Belmont, situated about a mile south of 
Front Royal. The purchase price was $40,000. 
The tract contains 825 acres, and has long been 
acknowledged one of the finest fruit farms in \'ir- 
ginia. The vineyards and wine cellars of Belmont 
had a national reputation when Marcus B. Buck 
owned and operated them, and it is said that Mr. 
Buck spent $200,000 in improving the property, 
which Mr. Warthen will restore to its former 
beauty. From the elevation of Belmont a view 
of the Shenandoah Valley for 20 miles may be 
had. It is understood to be Mr. Warthen's pur- 
pose to turn the present house into a handsome 
colonial residence. 



Dr. Arthur B. Clarke, class of 1906, is prac- 
ticing at Plantersville, S. C. 



Miss Lucy B. Squires, class of 1909, University 
Hospital Training School for Nurses, is located at 
226 East Duval street, Jacksonville, Fla. 



The editors of The Bulletin are very anxious 
to secure copies of The Bulletin for July, 1905 : 
January, 1907, and March, 1908. If any of our 
readers have copies to spare, they will help u-^ 
greatly by sending them to complete our files. 



Miss Henrietta Gourley, class of 1908, Univer- 
sity Hospital Training School for Nurses, who 
went to Fayetteville, N. C, to accept a position as 
superintendent of nurses at St. Luke's Hospital, 
has been compelled to resign owing to ill-health, 
and she is now with her brother-in-law, Dr. Guy 
W. Latimer, class of 1901, of Hyattsvillc, Md. 
Drs. R. B. Hayes, class of 1906, and T. Marshall 
West, class of 1908, own the hospital, and are, as 
Dr. West puts it, "pegging away" very hard 
toward the success we wish for them. It is likely 
that Miss Gourley will be succeeded by Miss Kim- 
mel, class of 1910. 



The annual commencement of the LTniversity 
will be held June i, 1911. 



We regret to report that our beloved Prof. 
Samuel C. Chew, class of 1858, is very ill with 
grippe. 



Among the recent visitors to the University 
Hospital was Dr. Louis Hamilton Seth, class of 
1907. 



Dr. .Aloysis \\\ Valentine, class of 1904, of 606 
N. Carolina avenue S. E., Washington, writes: 

"It seems that tlie Faculty should impress upon 
each graduate the importance and the value of 
pushing the school along after they leave it. The 
i\dvisory Council is a step in the right direction, 
but what is wanted is enthusiasm among the men 
turned out each year. C)ur hope lies in the recent 
graduates who are more receptive in catching the 
L'niversity idea. It seems as if the Alumni Asso- 
ciation is not active enough in securing new grad- 
uates. Cannot something be done to catch them 
before thev leave the shop, so to speak ? 

"Give my best wishes to the bunch, and save 
some for Dr. Randolph Winslow." 



The members of the class of 1885 are located 
as follows : 

R. L. Allen, Waynesville, N. C. 

C. W. Barker, 11 16 West Fayette street, Bal- 
timore. 

E. M. Beach, West Long Branch, N. J. 

Joseph Blum, 18 16 Madison avenue, Baltimore. 

G. F. Boucsein, Ellinwood, Kans. 

Leigh Buckner, iioi Franklin road, Roanoke, 
\'a. 



38 



THE HOSPITAL BULLETIN 



B. F. Bussey, Texas, Md. 

D. G. Caldwell, Concord, N. C. 

P. G. Dill, 1433 West Lombard street, Balti- 
more. 

John H. Dorsey, Glencoe, Minn. 

R. B. Epting, Greenwood, S. C. 

George Y. Everhart, Dickeyville, Md. 

Ira L. Fetterhoff, Carrollton and Lafayette ave- 
nues, Baltimore. 

Geo. M. Fickes, Seven Valleys, Pa. 

Alva G. Floyd, Fair Bluff, N. C. 

H. E. Gale, 260 West Hoffman street, Balti- 
more. 

Wm. F. Hall, Crisfield, ,Md. 

E. T. W. Flail, Freemansburg, W. A'a. 

J. T. Hering, 1728 St. Paul street, Baltimore. 
X. M. Hendricks, 1601 East 5th street, Dayton, 
Ohio. 

B. M. R. Hopkinson, Professional Building, 
Baltimore. 

J. X. Humrichhouse, Council Bluff's, Iowa. 

J. T. B. Hyslop, Bellehaven, Va. 

R. E.L.Johnston, 721 E street, I^Iemphis, Tenn. 

H. M. Julian, 7732 A-^irginia avenue, St. Louis, 
IMo. 

Louis C. Carrico, Bryantown, Md. 

H. L. Clark, Washington, Pa. 

Edw. C. Coleman, Kosciusko, Miss. 

John C. Cort, Clairton, Pa. 

A. C. Coble, Dauphin, Pa. 

H. C. Conley, Boone, Iowa. 

I. PI. Davis, Charles and Pleasant streets, Bal- 
timore. 

C. K. Jump, 1415 Madison avenue, Baltimore. 
Geo. C. Kinard, Lincoln, Pa. 

J. C. Lemmer, Oil City, Pa. 

J. C. Lockbridge, Driscoll, W. Ya. 

Lewis W. Morris, Salisbury, Md. 

V. L. Xorwood, 939 ^^'est Fayette street, Bal- 
timore. 

J. C. Perry, U. S. P. H. and :\I. H. S., Canal 
Zone. 

S. L. Phillips, 232 Bull street. Savannah, Ga. 

W. A. Flecker, Hampton, Va. 

John H. Reed, Logansport, Ind. 

Howard C. Reamer, Danville, Cal. 

A\'. J. Rivers, Eastover, S. C. 

C. W. Sawyer, Elizabeth City, N. C. 

Samuel Schwalbe, 6618 Michigan avenue, St. 
Louis, AIo. 

Wm. A. Shoemaker, 1006 Carleton Building, 
St. Louis, Mo. 



M. B. Shupe, Connellsville, Pa. 

J. Campbell Smith, 3750 Westminster boule- 
vard, St. Louis, Mo. 

G. \\'. Todd, Salisbury, Md. 

H. ^I. Thomas, 1228 Madison avenue, Balti- 
more. 

E. P. Turner, Ferguson's Wharf, Va. 

A. K. A\'arner, 1056 Belmont avenue. Chi- 
cago, 111. 

A. S. Warder, Grafton, \\^ Va. 

John A. IMurray, Patton, Pa. 

John P. Smallwood, Falls Church, A'a. 

J. Fletcher Somers, Crisfield, Md. 

Of the class three members — Frank Camm, G. 
Linton Shipp and F. I\I. Latham — have died, and 
we are unable to locate the following members : 
J. B. Carr, J. M. Emmitt, B. B. Halsey, E. K. 
Hardin, C. H. Janney, H. C. Jamison, D. T. E. 
Casteel, P. B. Carter, S. B. Dew. A. F. Keen, W. 
P. Kennedy, E. T. ^lay, C. E. Rogers and \\'. T. 
Spruill. 

If any of our readers know the present location 
of any of the above, will they kindly notify us 
immediately? The Bulletin wishes to correctly 
list each alumnus of the Universitv. 



Dr. Herbert Seth Anderton, class of 1910. is 
the guest of his brother in California. 



A campaign for funds will be launched in the 
near future to endow the department of pathology 
in the University of Maryland. 



Dr. J. Lewis Hanes, class of 1902, is located 
at ^^'inston-Salem, X'. C. 



According to the fifty-eighth annual report of 
the Xortheastern Dispensary, 1224-1226 East 
^lonument street, Baltimore, our alumni hold 
the following positions: Secretary board of di- 
rectors, Alexander D. AlcConachie, class of 1890: 
general medicine. Percy E. Lilly, class of 190 1 : 
eye and ear. Alexander D. McConachie, class of 
1890, and Josiah Sheer Bowen, class of 1903: 
gynecology, AVilliam S. Smith, class of 1883, and 
chief of outdoor clinic, Percy E. Lilly, class of 
1901. 



Dr. A. Aldridge ^Matthews, class of 1900, of 
Spokane, AVashington, who was for several years 
superintendent of the University Hospital, has 
succeeding in building up a very extensive sur- 



THE HOSPITAL BULLETIN 



39 



!;-ical practice in his adopted city. Dr. Alatthcws 
is a Marylander by birth. His brother, Dr. Jame^ 
G. Matthews, class of 1905, is associated with him 
in practice. 



We are glad to report that Mr. William L. D_\- 
erly, a member of the medical class of 191 1, who 
was operated upon recently for appendicitis, has 
sufficiently recovered to resume his studies. 



The General Alumni Association will tender a 
smoker and buffet luncheon May 30, 191 1, at the 
Medical and Chirurgical Faculty Building, 121 1 
Cathedral street, at 8.15 P. M., to the graduating 
classes of the several departments. This feature 
was inaugurated last year and will become an 
annual institution. 



Amongst our alumni located in North Carolina 
are : 

Albemarle. 

Jasper M. Anderson, class of 1895. 
William Isaac Hill, class of 1897. 
Virgil A. Whiteley, class of 1884. 

ASHBORO. 

Houston Boyd Hiatt, class of 1907. 

ASHEVILLE. 

Charles Collins Orr, class of 1904. 
Charles L. Scott, class of 1897. 

Bailey. 
S. B. Drew, class of 1885. 

Be.JiUFORT. 

Charles L. Duncan, class of 1902. 

Bethel. 
Guy F. Thigpen, class of 1903. 
Bryson City. 
Daniel R. Bryson, class of 1900. 

BURGAW. 

Peter Prentiss Causey, class of 1897. 

Burlington. 
Charles Manly Walters, class of 1908. 

Buxton. 
Judson J. Davis, class of 1891. 

Carthage. 
Gilbert McLeod, class of 1882. 

Casar. 
Thomas A. Mathews, class of 1890. 



Charlotte. 
James Ramsey Alexander, class of 1894. 
Ephraim M. Brevard, class of 1894. 
Andrew Johnson Crowell, class of 1893. 
Samuel McKee Crowell, class of 1895. 
John E. S. Davidson, class of 1894. 
John McC. De Armon, class of 1886. 
John Robinson Irwin, class of 1877. 
William R. McCain, class of 1897. 
Calvin S. McLaughlin, class of 1906. 
J. Pleasant Matheson, class of 1905. 
Charles H. C. Mills, class of 1897. 
Edgar Reid Russell, class of 1895. 
Charles Moore Strong, class of 1889. 
Charles E. Walker, class of 1891. 

China Grove. 
Banks Withers, class of 1896. 

Clinton. 
Frank Huske liolmes, class of 1895. 

COLERAIN. 

Luther A. Nowell, class of 1894. 

Columbia. 
Joseph L. Spruill, class of 1895. 

Concord. 
Daniel Greenlee Caldwell, class of 1885. 
James S. Lafferty, class of 1881. 
William David Pemberton, class of 1887. 
Francis Owenton Rogers, class of 1901. 

COOLEEMEE. 

John R. Lowry, class of 1904. 



BIRTHS 



Dr. Louis Cottin Skinner, class of 190 1, and 
Mrs. Skinner, of Greenville, N. C, are being con- 
gratulated upon the birth of a daughter, April 4, 
191 1, who has been named Elizabeth Minor. 



DEATHS 



Dr. Adolph Gustav Hoen, class of 1873, died at 
his home in Waverly, Md., March 29, 191 1. Dr. 
Hoen was born November 28, 1853, of German 
descent. His father was August Hoen, founder 
of the lithographic firm of A. Hoen & Co. of Bal- 
timore, and was born at Frankfurt-on-the-Main, 
Germany. His mother was Caroline V. Muth, 
and lived to a very advanced age. Dr. Hoen was 



40 



THE HOSPITAL BULLETIN 



educated in a private German school and Loyola 
College. He afterwards entered the University 
of Maryland, graduating in 1873. He started to 
practice in Baltimore, but because of ill-health 
removed to Burlington, Wis., where he remained 
for four years, returning to Baltimore in 1878. 
In 1894 he became identified with the anatomical 
department of the Johns Hopkins Medical School, 
having direction of the photo-micrographic labor- 
atory of this department, and continued as a part 
of the teaching force of the institution until the 
end of 1897. He then became director of tho 
clinical laboratory of the Suffern Sanitarium of 
New York State, a branch institution of the Pas- 
teur Institute of New York city, then under the 
direction of the late Paul Gibier, M.D. In 1900 
he became director of the Pasteur Institute of 
Virginia, located at Richmond, which position he 
filled until his death. In 1903 he also assumed 
the directorship of the histological laboratories of 
the L'niversity College of Medicine of Richmond. 
He was a member of the Medical and Chirurgical 
Faculty of Maryland, the Virginia State Medical 
Society and the Academy of Medicine of Rich- 
mond. Dr. Hoen married Miss Helen M. Nix- 
dorff, who survives him. He also leaves four 
children, Messrs. August, Stanley and Ralph 
Hoen, and one daughter, Ethel — Mrs. Benjamin 
Hanson, Jr. 



BOOK REVIEW 

Interxatioxal Clinics. A Quarterly of Illus- 
trated Clinical Lectures and Original Articles. 
\'ol. I, Scries 21, 1911. Philadelphia. iQii. 
S2.00. 

\\'ithout hesitation we pronounce this probably 
the most interesting volume of International 
Clinics yet issued. Its articles are on live subjects 
of the clay — Pellagra in the United States ; Treat- 
ment of Syphilis by "606;" Poliomyelitis Investi- 
gations : Open Treatment of Fractures ; Ulcera- 
tion of the Male Bladder; The Cellular Basis of 
the Determination of Sex ; Mosquito \A'i irk in the 
Canal Zone. 

The inclusion of Maryland on the colored map 
(frontispiece) among Southern States where pel- 
lagra is "prevalent" is probably unfair unless her 
10 cases came from her own borders ; and even 
then 10 cases of any disease in one year do not 
justify the label "prevalent." At the same time 
the attraction of professional attention to this 



curious disease (now said to be carried not by 
spoiled corn, but by the sand-flea), which blooms 
out in the surface tissues of a chronic patient in 
summer to vanish in winter so completely that 
among a hundred summer cases scarcely one win- 
ter diagnosis can be made (page 2) even by false 
numerical statements, is pardonable. 

Though Baltimore cannot get a suflicient num- 
ber of cases for one medical demonstration at so- 
ciety meetings, yet there may occur in the practice 
of any physician obscure cases which baffle de- 
tection. 



LABORATORY REPORT OF THE UNI- 
VERSITY HOSPITAL. 

Month of M.-^rch. 

Blood Examinations. 

Leucocyte Counts 158 

Erythrocyte Counts 12 

Differential Leucocyte Counts 6 

Hemoglobin Determinations 102 

Smears for Malarial Parasites 10 

Blood Cultures 2 

Wasserman Tests 25 

315 

Urine Examinations. 

Routine Urinalysis (chemical and micro- 
scopic ) 464 

Total estimation for Urea 23 

Total estimation for Albumen 10 

497 

Miscc'llancons. 

Gastric Contents ( chemical and micro- 
scopic) 15 

Feces (macroscopical, microscopical and 

some cases chemical examin.ation) ... 9 

Sputum Examination 25 

Bacteriological Cultures and Smears 

(from operative cases) 37 

Bacteriological Cultures (throat) 120 

Examination of Spinal Fluid i 

Section of Tissue for Microscopical Ex- 
amination 7,^1 

Autopsies 3 

243 

Total 1055 

Dr. J. L. IIiRsii, 
Dr. H. J. Maldeis, 
Dr. R. biLr.F.R. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest o£ the Medical Department o£ the University of Maryland 
PRICE $X.OO fER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., MAY IS, 1911. 



No. 3 



THE WASSERMAxNX REACTION. 



B_\' Herbert Schoenrich, AI.D., 
Baltimore, Md. 



^^'ith the rapid advancement made in ilie treat- 
ment of syphilis, hcginning with the more intelli- 
gent administration of mercnry, potassium iodide 
and arsenic, followed with the newer compounds 
of arsenic as arsacetin, atoxyl, arsenophen^dglycin, 
etc.. and finally with Prof. Ehrlich's famous rem- 
edy, dioxydiamido-arsenobenzol, and taking intii 
consideration the remarkable results obtained, the 
rapidity in the disappearance of lesions, we are 
confronted more and more with the serious ques- 
tions, "Is the patient cured? Has he syphilis; if 
so, to what extent? What are the possibilities of 
a recovery, of dangerous sequels, etc. ? The pro- 
fession will agree that there is no answer more 
reliable, more trustworthy, than the result of a 
A\'assermann reaction. Most all hospitals are 
carrying it out weekly in the laboratories ; special- 
ists are employing it in their office, and, in fact, 
parts of Europe the test has been accepted as a 
criterion in medico-legal court proceedings. 

It is not within the scope of this paper to go 
deeply into all the details of the test, nor to de- 
.scribe the many and varied modifications, but 
more to .give a comprehensive review covering 
the theory of the Wassermann-Xeisser-Bruck re- 
action and the technic employed. In order to un- 
derstand this test it is necessary to be informed 
in regard to the phenomenon of hemolysis, and 
to know what is meant by the Bordet-Gengue 
phenomenon. It has been a long-established fact, 
discovered by Belfanti and Carbone, that an ani- 
n'.al of one species acquires a specific htic power 
when injected with tlie washed red corpuscles ob- 



tained from an animal of anotlier species. If, for 
example, you take the washed red corpuscles of 
a sheep and mix them with the serum of a rab'iit 
in a test tube, there will be no change, and the 
corpuscles will gravitate to the bottom of the test 
tube, leaving the clear serum above. If, on the 
other hand, you immunize the rabbit with sheep's 
corpuscles, there will be formed in the serum of 
that rabbit a new body termed ainbocc[ttor, which, 
in the presence of coinplcincnt ( a constituent of 
all fresh, normal sera), has the power of bring- 
ing into solution erythrocytes. Thus, collect the 
serum from the immunized rabbit and treat it with 
sheep's corpuscles, and there will result a com- 
plete solution of the latter, and the rabbit is said 
ti^ be immunized against sheep's blood. This 
phenomenon is known as hemolysis, which means 
to lake, to render transparent an opaque suspen- 
sion of blood corpuscles ; and substances which 
cause hemolysis are said to be hemolytic for the 
blood corpuscles which they dissolve. The laking 
of blood is due to the immune body (amboceptor) 
combining with its specific red blood corpuscles 
in the presence of fresh complement. Substances, 
when injected into an animal capable of producing 
amboceptors, are known as antigens. Bordet and 
Gengue showed that in the same manner as spe- 
cific, immune bodies ( hemolytic amboceptor) are 
produced in animals injected with the blood of 
another species; by the injection of bacteria or 
nlbumanoid substances, immune bodies (ambo- 
ceptors) are produced in the injected animal 
\\hich will combine with the specific bacteria or 
albumanoid substance, respectively, in the pres- 
ence of complement. In using erythrocytes as an 
antigen the corresponding amboceptor is known 
as a hemolytic amboceptor. In the case of bac- 
teria it would be a bacteriolytic amboceptor, and 
when employing unorganized protein, as agg 
albumen or alien blood serum, the product formed 



42 



THE HOSPITAL BULLETIN 



in the animal is called precipitin. By heating 
amboceptor for a half honr at 56 degrees centi- 
grade, it will lose its power to dissolve blood cor- 
puscles, and is said to have been rendered '"in- 
activated." Inactivatecl serum, however, does not 
correspond to normal serum, for if vou add to 
the former a quantity of normal serum, it will 
again become activated, repossessing the property 
of hemolysis. This is explained by the fact that 
complement is destroyed when heated for a half 
hour at tlie tem]ierature of 56 degrees centigrade. 
Thus, when adding normal scrum to inactivated 
amboceptor, you are adding complement and re- 
activating tlie amboceptor. Amboceptor itself 
is more or less stable, and not easily destroyed 
by heat, and is said to be thcrmostabilc. Comple- 
ment is destroyed by heat or thermolabilc. In 
order, then, to bring about hemolysis, three agents 
are necessary, namely, antigen, amboceptor and 
complement, which together constitute a hemolytic 
system. An antibody can show its presence in 
serum by its power of fixing or taking up com- 
plement in a hemolytic system. This phenomenon 
of disappearance of complement in a mixture of 
antigen and antibod}' is known as "fi.xation ( an- 
choring or binding) of complement," or the l^>or- 
det-Gengue phenomenon. 

The W'assermann reaction depends upon there 
being something ])resent ( sxphilitic antibody) in 
tb.e serum of the sy])liilitic patient, which, in the 
l^resence of certain lipoid or fattv substance 
( antigen ) , has the ]:)ropcrty of taking up comple- 
ment, so that upon the addition of hemolytic am- 
boceptor and er\throcytes no hemolysis takes 
place. This binding of complement is made evi- 
dent by the fact that when you take syphilitic pa- 
tients' inactivated serum, and. adding antigen and 
fresh complement and incubate for an hour at 
2>7y:i degrees centigrade ( allowing them to unite), 
that, in spite of of the complement content, there 
will be no hemolysis by the addition of blood cor- 
puscles and amboceptor. On the other hand, 
assuming that the patient's serum were normal, 
1. e.. not containing the syphilitic antibody, there 
would be no com])lement fixation, and con.se- 
i|uently upon the further addition of amboceptor 
and blood corjniscles, the com])lemcnt. not having 
lieen fixed, would be free to act with the cor- 
puscles, and hemolysis would occur. (See 
I'lgure I.) 

Inasmuch as in syphilis it has been impossible 
t I obtain a pure culture of the specific organism, 



it was necessary to use as antigen an extract of 
syphilitic tissue known to contain the organism 
in large cjuantities. For this purpose e.xtracts 
were prepared from the livers of syphilitic fetuses, 
from the fact that livers were very rich in the 
fatty or lipoid element. Later it was shown, how- 
ever, that an extract made from normal fetal livers 
also contained an antigen similar to the one from 
a sypliilitic liver: in fact, it developed further that 
a variety of normal organs contained an available 
"antigen." namely, an extract froiu healthy guinea 
pigs' heart muscle, from guinea pig livers. Porges 
and Meier used lecithin as an antigen very success- 
fully. Other lipoid substances which have been 
experimented with are sodium glycocholate and 
taurocholate ( Levaditi) ; sodium oleate (Sachs 
and Altman) ; oleic acid (Sachs and Rodoni) ; 

FIGURE I. 



Aat. 



> > ^- "• ^- < < 



J)> \ Amb. <^ 



Ant. 



y> \ H. P. S. <^ 



> > ^^- < <c 



,\nr.— .Vnti;^i'U. S. 1', .s.— .Syphilitic patient's senini. C— 
Cnmplement. E. — I'Jrytbrocytes. Adi1». — Amboceptor. N. P. S. — 
Normal patient's uerum. 

cholesterin and vaseline (Fleishman) : sodium 
cholate (Noguchi). 

The reagents necessary to perform the test are 
five in number, namely, antigen, amitoceptor, 
blood corpuscles, complement and patient's serum. 

Antigen. — As has been intimated, one of a 
variety of antigens may be emplo\ed satisfac- 
torily. Xoguchi devotes a very interesting chap- 
ter to the preparation of antigens in his recent 
work on "The Serum Diagnosis of Syphilis." I 
have i^repared a satisfactory antigen from normal 
heart ( human) muscle. A quantity of heart muscle 
is passed through a hashing machine; of this lOO 
grams are weighed off and placed in a suitable 
glass jar. Add 500 c. c. of absolute alcohol, close 
jar tightly, and place it into an incubator for sev- 
eral days, or keep it at a temperature of 60 degrees 
centigrade for 24 hours. The solution is then 



THE HOSPITAL BULLETIN 



43 



liltereil and preserved in a well-stoppered bottle 
in a dark place. .\ntii^en is fairly stable, and 
when jireserved {jroperly will keep for a year or 
JDiiijer- With antigen pre])ared as described, a 
dilution of i in lo will usually suffice; it must be 
tested, bowever, from time to time, so as to ascer- 
tain that llie antigen tlilution does not cause com- 
plement fixation witb normal serum. Tbis is de- 
termined by makinjj a series of dilutions of antigen 
and combinino; them on the one band witb known 
s\i)bilitic serum, and on the other hand witb nor- 
mal serum. Note the dilution in wbicli the anti- 
<;en does not fix complement with normal serum, 
l.ut does fix witb syphilitic serum, and use that 
ii; vour test. In other words, the strongest solu- 
Uon of antigen is employed that will fix comple- 
ment with sypliilitic sera, but does not fi.x with 
normal sera. 

Aiiilwccptor. — A healthy medium-sized rabbit 
is inoculated witb the washed corpuscles of a 
sheep or chicken. The blood must be obtained 
directly from the blood vessel and collected in a 
sterile fiask containing sterile beads or broken 
glass, in order to facilitate the breaking up of the 
clot. After gentlv shaking the flask for a few 
minutes the blood is transferred into sterile cen- 
trifugal tubes and centrifugalized until the cor- 
jniscles are thrown down, leaving the clear serum 
above, which is replaced witb .85 per cent, sterile 
physiological saline solution. Tbis process of 
washing of corpuscles in order to rid them from 
their complement is repeated three or four times. 
Finallv sterile saline solution is added sufficient to 
make up the original volume of blood employed. 
The rabbit to be injected is tied down on an 
animal-bolder or held by an assistant. The usual 
aseptic surgical precautions should be observed, 
such as scrubbing up the abdomen witb soap and 
water, to be followed witb alcohol and a solution 
of bichloride. Shaving is not always necessary. 
The blood to be injected is drawn into a sterile 
syringe provided witb a needle of large caliber, 
which is inserted through the abdominal wall. 
The needle should be inserted through the muscles 
of the abdomen very gently and obliquely, and the 
peritoneum is entered by giving a slight jerk to 
the syringe perpendicularly. As the point enters 
the peritoneal cavity the resistance ceases sud- 
denly, and the tip of the needle becomes freely 
movable among the intestines. The greatest dan- 
ger to be avoided is the puncturing of the intes- 
tines. After a little practice, however, and by 



lowering the head of the am'mal, this danger is 
overcome. The fluid should always be warmed 
just previous to the injection by i^lacing the 
I.ieaker containing it in a vessel of hot water at 
about 45 degrees centigrade ; if not, the animal 
may die of shock. The injections are repeated at 
intervals of from five to seven days. The animal 
should be watched carefully, and if it does not 
feel well, if it is losing in weight, or if there is 
any tumor formatinn. the injections should he dis- 
continued for several days. Three to five injec- 
tions usually suffice, using the corpuscles from 
30 c. c. of blood, from 25 c. c, from 20 c. c-, re- 
spectively. .\ week following the last injection 
a few c. c. of blood are drawn from the rabbit's 
ear and the titre ascertained; if found unsatisfac- 
tory, another injection is given. Sheep's blood 
will give a higher titre than that of chicken. With 
three injections, using the quantities mentioned 
aljove, I have obtained a titre of 1-3000, using 
chicken blood. Care must be taken to avoid giv- 
ing superfluous injections, as the titre would 
thereby be reduced. One case known to me is 
where a titre of 1-300 was obtained with seven 
injections. 

Having obtained a satisfactory titre, the rabbit 
is again tied down on a board and anesthetized. 
After cleaning the parts thoroughly, the animal 
is bled either from the ear or from the femoral 
vessels, the blood being collected in sterile con- 
tainers, then defibrinated and transferred to sterile 
centrifugal tubes with sterile caps- After cen- 
trifugalization, the serum is carefully pipetted 
into test tubes, or preferably preserved in hermeti- 
cally-sealed beads of about i c. c. capacit\- and 
stored in a refrigerator. A properly-kept ambo- 
ceptor will last one year or longer, gradually 
losing its hemolytic power. 

It is imperative to standardize the amboceptor 
])revious to each test, in order to determine the 
smallest amotmt which will cause hemolysis of 
a 5 per cent, suspension of erythrocytes. This 
standardizing is also known as the titration of th-y 
omboccptor. Into a series of test tubes are placed 
dilutions varying from 1-500, 1-800, i-iooo, etc., 
of inactivated amboceptor with equal units of a 
5 per cent, suspension of erythrocytes and i c. c. 
fresh complement. Incubate at 37J/2 degrees cen- 
tigrade for an hour, shaking tubes at intervals, 
and note the highest dilution where there is com- 
plete hemolysis. Two units of this dilution are 
used in the test. I mav add that all dilutions in 



44 



THE HOSPITAL BULLETIN 



this work are made with .85 per cent, physio- 
logical saline solution. 

Blood Corpuscles. — The method of obtaining 
and washing the corpuscles is explained under the 
head of "Amboceptor." A 5 per cent, suspension 
in saline solution is used in the test. Another 
method is to use one drop of the original corpuscle 
mush for each tube, thus doing awa)' with the 
stispension. Corpuscles will keep a few days 
when kept on ice, after which they assume a dark 
color, being then unfit for the test. 

Coiiiplciiicuf. — This is represented in the scrum 
of the guinea pig; in fact this animal seems 
to furnish one of the best available complements. 
The methods commonly employed to obtain the 
blood are to anesthetize the guinea pig and either 
cutting the carotid or jugular, allowing the blood 
to flow directly into a sterile Petri dish, or by 
carefully drawing a few c. c. from the heart with 
a syringe. The latter method has the advantage 
that the guinea pig may live for a varying length 
of time, thus doing away with the expense of a 
different guinea pig for every test. The blood is 
placed in an icebox for several hours, or over 
night, after which the clear serum is pipetted off. 
A dilution of i in 10 is used in the test. The 
question may arise. "Why not use the comple- 
ment normally ])resent in the patient's serum?" 
The answer is that the patient's blood contains an 
indefinite amount of complement, and, as it is 
imperative to deal with known quantities, the 
complement of the patient's serum is destroyed 
by heating it at 56 degrees centigrade for a half 
hour- 

Patient's Blood. — The patient may be bled from 
the basilic vein, or by puncturing either the ear 
lobule or finger. The blood is collected in suit- 
able glass tubes and set aside in a cool place to 
clot. The scrum which has separated, and which 
should be absolutely free from corpuscles, is 
pipetted oft' and inactivated on a water bath. Care 
should be taken not to heat the serum above 56 
degrees centigrade, nor longer than a half hour, 
since the syphilitic antibody, which is more or less 
sensitive to heat, may be partly destroyed. The 
serum is diluted i in 5. 

The outfit necessary to carry out the reaction 
consists of a water bath, thermostat, refrigerator, 
a suitable cage for the rabbit and guinea pig, 
glass tumblers, beakers, a quantity of small test 
tubes, glass tuliing, pipctts of i, 2 and 10 c. c. 



capacity graduated in i-ioo, 1-50 and i-ioo, re- 
spectively, Petri dishes, centrifuge, Florence flask 
and a sterilizer. 

The test consists of the experimental tube on 
the one hand and a series of control tubes on the 
other. (See diagram.) • 

The reagents having all been satisfactorily 
standardized and properly diluted, we add to one 
set of tubes one unit each of patient's serum, com- 
plement and antigen ; to the other set the same is 
added, excepting the antigen, wFiich is replaced 
by saline solution. Allow to incubate at 37.5 de- 
grees centigrade for one hour, after which each 
tube receives two units of amboceptor and one 
unit of erythrocytes suspension. Again incubate, 
shaking tubes gently at intervals of .15 minutes, 
and remove all the tubes as soon as those not con- 
taining antigen show complete hemolysis- This 
varies from one to two hours. 

The tubes are now either centrifugalized or 
placed in a refrigerator for several hours. The 
degree of hemolysis may vary, depending upon 
the amount of syphilitic antibody present in the 
patient. Thus, 

-, +, ±, +, + + , + + + , + + ++, 

signifying negative, doubtful, suggestive, weakly 
positive, positive, strongly positive, very strongly 
positive, respectively. 

Owing to its extreme sensitiveness and com- 
plicacy, the test should not be entrusted to un- 
skilled hands, since some of the more experienced 
observers frequently meet with trouble, the causes 
of which may be manifold and require careful and 
untiring laboratory scrutiny. 



ni.\GR.\M. 

Experimental tube. 

(i) _, ^ Inknown scrum -j- antigen. 

complement, amboceptor and 
rpuscles. 
Control tubes. 

(2) I'nknown serum + complc- 
inent, anibocei)tor and corpus- 
cles. ( To prove that the scrum 
itself docs not fix complement. ) 

(3) Known syphilitic scrum -f- an- 
tigen, complement, amboceptor 
and corpuscles. (To ]3rove that 
the antigen will fix complement 
with syphilitic serum-) 



Q con 

^— ' con 
tubes. 

o 
o 



1 



THE HOSPITAL BULLETIN 



45 



(4) 



(5) 



(6) 



(7) 



o 



o 
o 



o 



Known syphilitic scrum -|- 
coniplement, amboceptor auvl 
corpuscles. (To prove that tin; 
positive serum will in itself not 
fix complement.) 

Known hcallhy serum -|- an- 
tigen, complement, amlioceptor 
and corpuscles. (To prove that 
antigen will not fix complement 
in negative serum.) 

Known healthy serum -f- com- 
plement, amboceptor and cor- 
puscles. (To prove that the 
negative serum will not fix com- 
plement.) 

Antigen -|- complement, am- 
boceptor and corpuscles. (To 
prove that the antigen will not 
fix hemolytic system.) 



Tube 3 should show absence of heiuolysis. 
Tubes 2, 4, 5. 6 and 7 should show complete 
hemolysis. Tube i, of course, depends upon the 
nature of the serum. 

Since ^\'assernlann first reported this reaction, 
in I90.'>. numerous modifications have been ad- 
vanced, a majority depending, however, on the 
tlieorv of complement fixation. Some of the more 
comnidn modifications may be mentioned, viz. : 

Tschernogubow, Bcrliih Klin. Wochcnschr., 

1908, \o. 47, and Deutsche Med. ]]-'ochenschr., 

1909, Xo. 15. 

Weidanz, Deutsche j\led. U'oclieiischr., 1908, 
No. 48. 

Xoguchi. Jounial of Amerie. Med. Associat.. 
1908, Xo. 22. and Munch. Med. U'oeh., 1909, 
No. 10. 

Hecht. J Tien. Klin. U'ocliensehr.. 1908, No. 50. 
and 1909, Xo. 10. 

Fleming, Lancet. 1909, 4474. 

Stern, Zeitschr. f. Inununitatsforscliung, 1909, 
Vol. I. 

Bauer, Deutsche Med. JJ'oehenscIir., 1909. 
No. 10. 

Detre and \'. Brezovsky. IJ'ien. Klin, ll'och- 
cnschr., 1908. 

The statistics regarding the diagnostic value of 
the W'asserniann reaction are most gratifying. 
Although this subject may be discussed at length. 
I will limit myself by briefly saying that in 
primary lues a positive reaction is present from 



60 to 70 per cent. ; in secondaries with symp- 
toms, from 9S to 100 per cent.; in secondaries 
withnut symptoms the percentage ranges some- 
what lower. Late syphilis, including tertiary 
cases, give about 90 per cent- positive reaction. 
(Matson. in the Aincrican Journal of Derma- 
toloi^iy of August, 1910, devotes an interesting 
article on the Wassermann, based on 2667 cases.) 
A positive reaction may be obtained in lupus ery- 
thematoses, framboesia, trypanosomiasis, leprosy, 
scarletina, tuberculosis, and occasionally in ma- 
laria. Also in chronic diseases accompanied by 
marked emaciation near death, this is especially 
true with tuberculosis, but under such circum- 
stances there is usually no question of a ditteren- 
tial diagnosis of syphilis. A positive case may- 
give negative reaction, because, firstly, the virus 
has disappeared or is dormant, and there is no 
specific antibody in the serum ; secondly, the pa- 
tient is taking mercurial treatment, or thirdly, may 
form that small percentage who. in any case, may 
give a negative reaction. 

In conclusion I may say that in all doubtful 
cases of syphilis a Wassermann test is by all 
means indicated. Patients under treatment for 
a year or more should have their blood tested from 
time to time. It is surprising to note the change 
from a stronger to a weaker reaction in some 
patients who have been under heavy treatment but 
a few weeks. Practitioners should become more 
familiar and conversant with its possibilities, and 
realize that in the ^^'assermann test they have a 
valuable diagnostic agent at their command. 

REFERENCES. 

"Die ^lethoden der Immunodiagnostik imd Im- 
munotherapie," Dr. Julius Citron. 

Porges and ^leier, Berliner Klin. Jf'ochen.schr., 
1907, p. 1055- 

^^'assermann, Neisser, Bruck. Deutsche Jlfed. 
U'ocliensehr., 1906, p. 745. 

Fox, iV. Y. Medical Record. 1909, pp. 421-42S. 

Sachs. Journal A. .U. A.. 1909, 929-936. 

Xoguchi, "Serum Diagnosis of .Syphilis," Jour- 
nal E.v. Med-, 1909, pp. 392-401. 

Matson, American Journal of Dermatology, 
1910, pp. 361-371. 

TT34 Linden Avenue. 



46 



THE HOSPITAL BULLETIN 



SHOULD ALL .MEDICAL STUDENTS 
SEEK HOSPITAL APPOINTMENTS? 



By Charles Baglev, Jr., ^I.D. 



A student matriculating in a medical college is 
passing another milestone of his career; his am- 
bition is to complete the course creditably and 
receive a diploma. As he approaches graduation 
and the anticipation of the diploma is to become 
a realization, he is astounded with the fact that 
this is not all he desires and his course in the 
school has only been a means to an end ; namely, 
the practice of medicine. !Men who enter a medi- 
cal school calmly, almost thoughtlessly, tremble 
as the time approaches for leaving it : for no one 
knows better than they how inadequate is the 
instruction which has been imparted if it be re- 
garded as a final preparation for practice. This 
instruction is not a completed edifice ; it is a 
mere assemblage of building materials, valuable 
if ultimately cemented together by clinical experi- 
ence, but little more than useless rubbish if not 
supplemented by the binding power of knowledge 
gained at the bedside. 

In considering the question, almost any con- 
scientious student will conclude that hospital ex- 
perience is advantageous, and often a necessity, 
in accomplishing his real purpose, so I will not 
dwell upon the question of the necessity of hospital 
work, but will ask you to concede me this truth 
in order that I may utilize the time in attempting 
to point out to those seeking positions how they 
n:ay procure and retain them to the good of the 
patients, the profession and themselves. Again, 
I do not want to appeal to those who can readily 
find and acceptably occupy positions, but I wish 
to speak particularly to those who are not so for- 
tunately situated, and to whom the filling of a 
hospital position is a great undertaking. 

In attempting to bring this class of students 
and the hospital position into a happy relation we 
must first lay down what may be considered the 
iileal course to pursue. This course will at first 
sight seem impossible, but in the words of Robert 
Herrick, "We must attempt the end. and never 
stand to doubt ; nothing is so hard but search 
will find it out" 



The ideal course may be briefly outlined as 
follows : 

1. Bedside work during the senior year. 

2. Laboratory work during first year after 
graduation. 

3. Two years in the medical service of a good 
hospital. 

He must now look over the work of the years 
since his graduation with a critical eye, not spar- 
ing. a strict judgment of himself, and upon the 
conclusions reached formulate a plan for his life- 
work. 

One of three courses will be open to him : 

1 . To enter general practice. 

2. Seek special medical training. 

3. To launch into surgery. 

If he decides to enter general practice, he should 
spend the following year in the surgical service. 

If special medical training is desired, he must 
continue in the medical service three years- 

If surgery is decided upon, he should seek an 
appointment in the general surgical service and 
learn by close application for four years the gen- 
eral principles. 

If he desires to enter a special surgical field, 
such as eye and ear, nose and throat, or genito- 
tirinary surgery, an appointment in the special 
service should be sought, after having spent one 
year in general surgery. Thus, six or seven years 
must be given to this, the most important period 
of the physician's career. To many this would 
seem appalling, and cause great discouragement, 
but we must remember that this very plan is be- 
ing followed by many physicians throughout the 
country at the present time, and it is safe to say 
that from this class men will be .sought to fill the 
higher positions of the profession. The course 
we know would not be difficult to the student with 
unlimited means and exceptional ability, but I wish 
to show that the student, though lacking these 
valuable assets, may accomplish the end by realiz- 
ing that his future is not in anxiety for what lies 
dimly in the distance, but to do well what lies 
immediately at hand. 

One of the most frequent replies obtained from 
a medical student is that he would be very glad 
tc accept a hospital appointment, but it is neces- 
sary for him to establish himself in practice and 
pay off the debt which he has incurred by his 
several years of study, believing that his first duty, 
after receiving his diploma, is to return the money 
to those who have so graciously supplied him with 



THE HOSPITAL BULLETIN 



47 



tlie necessary funds diirini^ his course, often for- 
getting that the greatest debt he owes to those 
who have sent him to college is to enhance the 
education which has been given him. An addi- 
tional debt must be incurred to establish an office, 
and may mean the placing of another mortgage ; 
whereas, if he accepts the hospital position with 
all living expenses, but a small amount of money 
will be required, and the relief to his friends will 
be much greater. If a student finds himself with 
absolutely no means, and perhaps a debt upon 
which he must begin payments, he should seek a 
lower position on a hospital staft" which may carry 
with it a small salary. He may accept this position 
with the assurance that success in hospital work 
depends upon the man rather than upon the posi- 
tion which he may be given. Indeed, I have seen 
instances where physicians appointed to act as 
substitutes during the vacation period of the regu- 
larly-appointed residents have proven themselves 
so valuable that extra positions have been created 
for them, in order that their services might not be 
lost to the institution. It is astonishing and very 
gratifying to observe that financial difficulties 
often become insignificant as the professional 
ability of the resident is demonstrated and the in- 
stitution realizes that he is not only the happy 
possessor of a diploma, but the master of knowl- 
edge by which he is soon to become useful to the 
profession. 

Another difficulty frequently encountered is 
that the student has not made the best use of his 
opportunities during his course, and is imable to 
prove to the hospital trustees that he is able to fill 
their good positions. To these men I would advise 
intense earnestness and a determination to enter 
the field, to await an opportunity for a few 
months, as positions are unfortunately vacated 
occasionally, either by sickness or otherwise, and 
a very attractive opening may be found. 

A careful examination of the hospitals of this 
city at the present time would reveal the fact that 
many have been forced to fill vacancies with men 
not worthy of good positions, the desirable candi- 
dates having become impatient and established 
tliemselves perhaps in a rather half-hearted man- 
ner in general practice. Do not remain idle during 
the summer months- Seek a position in a dispen- 
sary, a summer camp, in a physician's office or as 
substitute in some hospital, always looking with 
a determination to the much-coveted goal. 

Having claimed your first hospital position, be- 



gin at once to qualify for a higher position by 
work, study, conscientiousness, sobriety and pa- 
tience. Newly-appointed residents too often view 
themselves with satisfaction, forgetting that these 
positions have existed for years, and have often 
been filled more acceptably than they are going to 
be able to fill them. It is the duty of a resident to 
e.xact much of himself. He should be unsatisfied, 
to be able to fill them. He should be unsatisfied, 
as this is but the portal, the initial step, of the 
large temple which he is to explore. He must 
not be dissatisfied, however, as the difficulties he 
will encounter, while new to him, have been en- 
countered and overcome by those who have trav- 
eled before him. 

I have mentioned work as a qualification, but 
will only attempt to touch upon the importance of 
this work in this connection, as the student may 
find an entire lecture given to its consideration 
in the "Master Word in Medicine,"' by Dr. Osier. 
By work the stupid man among you is made 
bright, the bright man brilliant and the brilliant 
student steady. Let us consider for a minute 
what would be the proper amount of work for the 
physician holding a position of this character. To 
begin with, I think the standard should be placed 
at the point of physical tolerance, daring to go to 
this point only, for with the proper amount of 
work success is assured, unless energy fails. By 
carefully arranging your mode of living you will 
be capable of a greater amount of work with less 
risk of becoming a physical wreck. We know- 
that many are dead ere their prime, sacrificed tc> 
carelessness of habits in living and neglect of ordi- 
nary sanitary laws. During the early part of your 
struggle you will be able to spare but a very small 
portion of your time, energy and money for social 
pleasures. 

Rest and diversion are necessary, but the stu- 
dent too frequently arranges these at the expense 
of his training- Do not forget the words of Cow- 
per. who said "that absence of occupation is not 
rest ; a mind quite vacant is a mind distressed." 
A yearly appointment soon passes, and you must 
endeavor to grasp every opportunity afforded by 
the position. When you are discouraged and un- 
able to see the results of your labor, do not sit idly 
down and bemoan your fate, but remember the 
master word and continue to work, never forget- 
ting that a young man in years may be old in hours 
if he hath lost no time. In idleness alone there is 
perpetual despair. 



48 



THE HOSPITAL BULLETIN 



Your work should begin between 7 and 8 A. 
M. and continue without interruption, except for 
limch, until 6 P. j\I. The evening should be spent 
in study, not only of textbooks, but of current 
medical literature and recourse to the Index 
Medicus. 

Lay hold upon the valued function of attend- 
ing carefully to the details of your work. Let 
this become a second nature, an attention com- 
pelling characteristic. Avoid the danger of ward 
rounds becoming a mere passing through the hos- 
pital twice daily, as required by the hospital rules. 
Acquire the habit of having all details arranged 
for the rounds of the visiting physicians. Make 
a careful study of methods of physical examina- 
tion, the action of drugs, the effects of food, the 
draining and dressing of wounds, noting care- 
fully the progress of the disease upon the chart, 
never forgetting the comfort of the mind and 
body of the patient- Wake an exhaustive study 
of diseases as they occur in the wards ; that is, 
the study of typhoid fever during the summer 
months rather than wait until winter, w hen this 
disease will be replaced by pneumonia. The best 
method of studying a disease is to collect all cases 
occurring- in- the service and report them to the 
clinical society. In the operating-room you must 
first learn to be prompt and quiet, and spare no 
efforts in learning well the fundamental prin- 
ciples of operating. A good operator must first be 
a good assistant, and an assistant of high rank 
must learn well the lesson of forethought, con- 
centration and anticipation, and closely apply the 
same during each operation. When you have 
demonstrated your ability to assist the operator, 
you will find opportunities to operate ; perhaps not 
frequently at first, but the frequency of these op- 
portunities will depend upon the use you make of 
the first few. In working remember that the man 
who is making satisfactory progress is going to 
be called u]ion to perform duties in themselves 
very unattractive, but if you are too big for the 
small duties you will continually find that the 
large ones are too great for you. 

Enter upon your duties with a determination 
to be patient, rememliering that you are fighting 
for a high jiosition in the profession — for a posi- 
tion to which there is no royal road. Do not ex- 
pect recognition of each individual noble act you 
perform, or praise for your personal qualifications. 
Able residents have lieen known to believe that 
they are more capable of conducting the treatment 



of patients than their visiting physicians, and I 
can recall a few sad instances where these able 
men have rendered themselves almost useless in 
the ward by attempting to discharge the duties 
of the visiting physician, whereby the details of 
his own work have been neglected, that of the 
visiting physician interferred with, a complete 
failure resulting, the patient often paying the 
price. The coveted prize is worth a high price, 
and you must repeatedly render valuable aid with 
apparently no recognition before realizing a profit- 
able return. The seeds of genius must be scat- 
tered to the winds, and though some may perish 
among the stony places of the world, and some 
may be choked by the thorns and brambles of 
early adversity, yet others will now and then strike 
root even in the clefts of the rock, struggle 
bravely u]) into sunshine and spread over their 
sterile birthplace all the beauties of vegetation. 

Study carefully an address, and be able to ap- 
proach the patient and his family in a manner that 
will gain their confidence for the institution and 
yourself. 

Conscientiousness is an absolutely necessary 
requirement, for by this means only can a phy- j 
sician be honest to his patients, his companions 
and himself. You will have responsibilities rang- 
ing from the care of hospital property to that of 
a human life; your opportunities to deceive your 
superiors will be many, and you must continually 
guard against this evil. Hospital internes have 
but a slight idea of their real importance in the 
work of a hospital which aims to attain or main- 
tain high standing. If their superiors find their 
orders are carried out in a perfunctory, half- 
hearted or careless manner, after a few attempts 
to correct these faults in the internes, and finding 
their efforts vain, they give up in disgust their 
attempts to better their service, the patients' suf- 
fering, and the standing of the hosjjital falls. 

A few years devoted to a proper preparation for 
a high future may seem appalling at first, but 
when they have been wasted in endeavor to battle 
with the crowd for a paltry position, they seem 
little, indeed. Physicians so frequently allow 
themselves to be decoyed from hospital positions 
by offers to labor in other fields with attractions 
apparently greater. This attraction is almost uni- 
versally money, and one is frequently asked by 
residents if he would not be standing in his light 
by not giving up his hospital work to accept a 
position paying a few dollars more a month. To 



I 



THE HOSPITAL BULLETIN 



49 



the man who is loiiging for an opportunity of this 
rank, and wlio lacks the full a]i])reciation of the 
principles of a hospital position, it is often ini- 
possihle to impress upon him that he is making a 
mistake. I believe that an offer of this kind 
should simply make him feel that his value has at 
last increased to the point of this otfer, and then 
see if this salary can be considered the height of 
his ambitiiin. If not, he should continue in the 
hospital work until some offer is presented which 
measures more nearly with his ideal. It is true 
that the ideas of success are different, but it 
should be your duty to place your idea as high as 
possible, remembering that you are far more likely 
to come below that mark than you are to go above 
it. Do not give up your hospital positions in 
order to better yourself during the first few 
months of service, but remember that it is not 
only your dut^' to serve the institution during the 
time for which you have been appointed, but it 
is also your duty to yourself to enhance your edu- 
cation by this means as far as possible. You are 
to embark upon your lifework, and this must be 
with a definite purpose, and with the proper 
knowledge of the work you are to perform. Avoid 
becoming a member of that class of physicians 
who ruthlessly trample over the bodies of poor 
and helpless victims, and thus at last enlightened 
escape from the mazes of their ignorance and 
attain real proficiency, or to the class beginning 
with deeply-rooted misconceptions, doomed to 
perpetual blunders which will cost the public dear, 
or to the group affrighted at the dangers that beset 
them, quickly abandon medicine for some less 
difficult field. 

In conclusion I wish to anwser the question by 
which this paper is titled by reading an extract 
of a letter I received from a former student who 
resigned his hospital position after serving but a 
few months to enter general practice. He writes 
as follows : 

"One has to do a little of everything when he 
is oft' in a town like this- I am called upon to pull 
teeth, do a little surgery, and last month I was 
ordered to make a post-mortem examination. It 
is a good experience to round a fellow out and 
let him put by a little money. Later he can go to 
a large city and specialize. This is my intention." 

Is it not evident that this man, desirous of 
reaching a special field, has allowed the golden 
opportunity to pass ? In order for him to satisfy 
his ambition, it will cost his patients dear, and 



much time must be contributed by him. There 
can be no doubt that hospital work and hard work 
oft'er the quickest and best means of raising the 
ambitious physician to the loftier levels of supe- 
riority, which I earnestly hope it will be the good 
fortune of all rif \'ou to reach. 



SYJVIELUS. 



By L. E. Xe.xle, AI.D., 

Professor of Obstetrics, Unk'ersit\ of Maryland, 

and 

J. M. Elderdice, M.D. 



Dr. John M. Elderdice (Class 1905) of Mar- 
della Springs, Md., recently sent to Professor 
Neale the accompanying photographs of a human 




monster that apparently belongs to the variety 
known as Symelus. 

In the magnificentlv illustrated work of Hirst 



50 



THE HOSPITAL BULLETIN 



and Piersol on Human Monstrosities (Ed. 1891), 
in Professor Neale's library, it is found that tliis 
product of conception belongs to the order of 
"autositic single monsters, capable of an independ- 
ent existence." ( Part I, page 83.) 

"The characteristics of this order are mainly- 
arrest of development, fusion and displacement of 
important parts of the Ixidy." 

In the Symelus variety of this order "there is 
more or less fusion of the lower limbs, but two 
feet are to be distinguished," and such seems to be 



MEDICINE AND SURGERY IN SAN 
DOMINGO. 




indicated in one of the photographs of Dr. Elder- 
dice's specimen. 

The doctor states that the child was born alive 
of a colored woman H) years old, in her first preg- 
liancy. It presented by the breech and lived 30 
minutes after birth. There was no evidence of 
vexual organs in the specimen. We hope that Dr. 
lUderdice will present this specimen to the college 
iuuseum. 



By M.VNUEL E. M.\LLEN of San Domingo, W. I. 
Senior Medical Student. 



Mr. \\'illiam Bycrly and ^Ir. Lee of the senior 
class are acting as assistant obstetricians in the 
maternity department of the I'niversity Hospital. 



Thousands of people in the United States are 
so busy every day unraveling the many perplexing- 
problems of medicine and surgery that they prob- 
ably give but little thought to what is being done 
by some of their close neighbors. San Domingo, 
the oldest of civilized places in the ^Vest Indies, 
has almost a million inhabitants, covering a large 
area. There are seven well developed and modern 
cities, which have from 15,000 to 35,000 inhabi- 
tants ; of these Santo Domingo City is the capital, 
with a population of 20,000 people. The country 
abounds in plantations of variable proportions in 
which is grown cof¥ee, tobacco and cane, which 
comprise the principle exports of the island, and 
which ofi'er a means of livelihood for many thou- 
sands of people. There is much American money 
invested in sugar refinery plants. With this very 
brief introduction to the island, I will discuss 
what the profession of medicine is, and what it 
is doing. There are about 500 graduates of medi- 
cine practicing on the island, allowing one doctor 
to every 2000 persons. Most of these men are 
graduates of medical schools in France and some 
from the Department of Medicine of the "Insti- 
tuto Profesional de Santo Domingo," an institu- 
tion embracing three departments — law, phar- 
macy and medicine. Alopathic medicine is ex- 
clusively practiced, the fanaticism of Christian 
Science and other allied new doctrines which 
hold the "secrets" of cure for so many American 
people have not even gained an entry among the 
people. The laws concerning the practitioners of 
medicine are not as well developed probably as 
here ; we have no examining State board, merely 
a registration board, which is composed of prac- 
ticing physicians appointed by the Government, 
and the candidate for practice presents his di- 
ploma with a certain sum of money, and if he has 
graduated from a recognized medical school he is 
given ]iermission to practice in the provinces. 
Our country is one in which the specialist is un- 
known : cverylDody is a general practitioner and 
has to take care of evervthing that falls into his 



THE HOSPITAL BULLETIN 



51 



hands. There are niaii)' hospitals throughout the 
island. Some are owned by the Government, 
some by Catholic churches and some are private 
institutions. ]\lost of these hospitals are well 
equipped with modern facilities for operating on 
and caring for the sick. Most large plantations 
make contracts with physicians to attend to their 
sick laborers. There are no medical societies, 
and naturally not a great deal of misunderstanding 
exists among the profession. 

As far as a financial success goes, medicine 
offers about as lucrative a means of livelihood as 
any of the learned professions ; the charges for 
services have about the same range as in this 
country. All physicians advertise in the news- 
jiapers, but have no signs on their doors. l)h- 
stetrics is the one branch of medicine practiced 
in a ver}" crude way, midwives being almost ex- 
clusivelv employed. Of course, medicine is crude 
as compared with its development in the United 
States, but in the past few years there have been 
great strides made towards perfection, and prob- 
ably in a few years to come the situation wil! 
present a more favorable picture. There is a 
school for teaching medicine, supported by the 
Government, and open to all natives who have 
sufficient preliminary education. There is no 
charge for tuition and the faculty is not paid, 
and there are generally iabout 40 students en- 
rolled. The course covers a period of three years. 
After graduating most men go to France to take 
a post-graduate cour.se. The lectures are deliv- 
ered in Spanish, but text-books of French authors 
are chiefl}' used. Most diseases of the tropics are 
seen here, although some with great rarity. Hook- 
worm disease is very prevalent and many forms 
of intestinal parasitic diseases. Malaria is ex- 
ceedingly common, but is gradually decreasing in 
frequency, as the people are appreciating the 
mosquito as the principal causative factor, and 
crusades for its e.xterminatiort have been started. 
marshes being sprayed daily with crude oil. 

Malaria tends to occur in Santo Domingo in 
the most pernicious forms and has caused many 
deaths, so the fact that our people are awakening 
to preventive medicine to this extent may mean 
that further strides will be made in the near 
future. Xo steps have been made yet towards 
combating the hookworm. Among tropical dis- 
eases which are seldom seen in this country we 
mav mention ecchinococcus cvst and amebic 



abscess of the liver. There seems to be a general 
predisposition towards simple ulcers of the skin, 
so much so as to be called "endemic ulcers of the 
skin in the tropics" in text-books. Sugar manu- 
facturing plants suppl\- the hospitals with accident 
cases. Cholera, bubonic plague, yellow fever and 
leprosy are still to be seen. Opium and cocaine 
habitues are verv rarely to be seen down there, 
although alcoholics are as prevalent there as in 
any other part of the world. Beri-beri, tubercu- 
losis, diabetes, elephantiasis and erisipelas occur 
with a marked degree of frequency. As far as 
venereal diseases are concerned, syphilis and 
gonorrhea occur with disgusting frequency. 
Chancroids are rare. Abdominal surgery in .Santo 
Domingo is not much practiced, due to lack of 
material, though appendicitis, gastric carcinoma, 
hepatic affections and renal calculi are to be 
found. 



COMPLICATIONS OF GASTRO - ENTER- 
OSTOMY. 



By Charles L. Schmidt, 
Senior Medical Student. 



The complications following this operation are 
numerous, and I therefore deem it advisable to 
mention them in the order of their gravity from a 
clinical standpoint. They are as follows : 

1. Regurgitant vomiting. 

2. Subsequent contraction of the anastomotic 
opening. 

3. Peptic ulcer of the jejunum. 

4. Chest complications. 

5. Perforation, owing to want of union at point 
of anastomosis. 

6. Adhesions subsequent to this operation. 

7. Internal hernia. 

8. Death from asthenia. 

9. Hemorrhage. 

I. REGURGIT.IlXT VOillTIXG. 

Formerly this complication was very common, 
and when severe was often fatal. Todav it is 



THE HOSPITAL BULLETIN 



rarely seen unless the technique is faulty. It is 
due to obstruction to the onward passage of the 
duodenal contents either from paresis of the in- 
testine, by adhesions, by pressure beyond the 
jejunal opening, by formation of a spur at the 
opening point of anastomosis, by acute angulation 
or kinking of the jejunuiu beyond the anasto- 
luotic opening, or by compression of the colon by 
the jujunal loop. This complication, which is a 
serious one, has been proven clinically to be trace- 
able to faulty technique. 

II. COXTR.\CTION OF THE NEW ORIFICE. 

There is always a certain degree of narrowing 
of the new orifice, but this can be avoided by mak- 
ing the opening not less than two inches and ap- 
proximating the mucous membrane properly. 

III. PEPTIC ULCER OF THE JEJUNUM. 

Peptic ulcers are very common in the stomach 
and very likely more common in the duodenum 
than is supposed, but are rare in the jejunum. The 
cause of jejunal peptic ulcer is the same as the 
gastric or duodenal variety. The peptic ulcer of 
jejunum complicating gastro-enterostomy is seen 
to follow the anterior more frequently than the 
posterior variety. This complication may occin^ 
from seven days to six or seven years after the 
operation, and may or may not perforate the in- 
testine. 

IV. CHEST CO.MPLIC.VTIOXS. 

Pneumonia and pleurisy following this opera- 
tion are not more frequent than following other 
abdominal operations. Some claim general anes- 
thesia as a potent factor in its causation. This, 
however, is an erroneous idea, for they (chest 
complications) tend to occur even under local 
anesthesia. JNIayo states that the latest theory is 
that some of the blood returning from the stom- 
ach does not go to the liver, and that infected 
emboli are deposited in the lungs. 

v. PERFOR.^TION. 

This is a serious complication and very often 
fatal. It rarely happens when union is procured 
by sutures. The use of the Murphy button seems 
to be an important etiological factor in its occur- 
rence. 

VI. .VDHESIONS. 

If the operation be a thoroughly aseptic one, 
and hemostasis perfect, this complication would 
indeed be uncommon. 



VII. I\TERX.\L HERNIA. 

This may occur by the passage of the small in- 
testine through the loop formed above the junc- 
ture of the jejunum and stomach by a small piece 
of intestine passing through the slit in the meso- 
colon, and lastly, in the posterior operation, the 
whole small intestine passing over the efferent 
loop and becoming strangulated. 

\ni. DE.\TH FROM ASTHENI.\. 

This complication formerly was rather com- 
mon, but is very rare today. Ten to twenty years 
ago, after the operation, the patients were not 
fed until they were well on to the road of recov- 
ery ; and, again, they were not operated on until 
they were extremely weak. These two factors 
were the chief drawbacks to a successful issue. 
Today patients are given one ounce of hot water 
in i6 to 20 hours following operation, which is 
increased as tolerated, and in 36 hours liquid food 
is permitted. 

IX. HEMORRHAGE. 

Hemorrhage is not likely to cause death, be- 
cause of the fact that the sutures used go through 
the whole thickness of the anastomotic opening, 
and therefore act as a compress to the vessels. 
However, it may occur^y erosion of a vessel wall 
by an ulcer or a cancer, as it may have done 
though gastro-enterostomy had not been per- 
formed. 

COXCLUSIOXS. 

The Murphy button is always connected with 
uncertain results. If the new orifice is made too 
small, a relapse may follow. Any method which 
does not aim at the proper continuity of mucous 
membrane is apt to be followed by too complete 
closure of the opening. The risk of peptic ulcer 
in the jejunum is under 2 per cent., and if the 
opening is made large enough, and the posterior 
operation performed, the percentage is less than 
I per cent. 



The friends of Dr. Norman F. Hill, class of 
1882, will regret to learn that he is seriously ill 
at the Mercy Hospital. 



Dr. Robert Lewis Mitchell, class of 1905. is ill 
at the Sydemham Hospital with scarlet fever. 



THE HOSPITAL BULLETIN 



53 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan VVinslow, M.D., Editor 



Baltimore, May 15, 1911. 



THE ENDOWMENT FUND OF THE DE- 
PARTMENT OF PATHOLOGY. 

\\'e are actively at work trying to raise this 
fund of $100,000. Tlie fruition of our hopes is 
not yet in sight, but we are making progress. We 
wish to put an appeal in the hands of every living 
ahinnuis, and shall come very near doing so. We 
hope those who have benefite(^by the opportunities 
afforded them at the L'niversity of I\Iaryland, and 
who have prospered in their work, may in their 
turn aid their Alma Mater in accomplishing this 
task. Our need is a very urgent one, and we are 
taking the only means available to us to meet the 
issue. Of course, we shall appeal also to the 
citizens of Baltimore, but we ought to be able to 
show these citizens that our own alumni are doing 
all they can to aid us in our effort. 

The handwriting is on the wall ; the inien- 
dowed medical school cannot much longer exist. 

Brothers, help us to put our Alma Mater on 
such a sure foundation that when the rain de- 
scends, and the floods come, and the winds blow 
and beat upon our house, it may not fall. 



CLOTHE APPEAL FOR THE PATHOLOGICAL 
DEPARTMENT. 

The Facultv of Physic, being firmly convinced 
that the scientific chairs of a medical school 
should be filled b}- scientists who give their whole 
lime to the duties of their chairs, and not by 
practitioners of medicine, have appointed Drs. 
Randolph Winslow, John C. Hemmeter and 
Arthur M. Shipley a committee to devise means 



to bring about this important change in the School 
of Medicine of the University of Maryland. 

The aid of our alumni and friends is therefore 
asked in raising the sum of $100,000 for the en- 
dowment of the Department of Pathology. 

Any amount that you may feel able to con- 
tribute to this object will be gratefully received, 
as will also any suggestions or other assistance 
that may expedite our purpose. 

This fund will be administered by "The Trus- C 
tees of the Endowment Fund of the University of 
Maryland,"' an entirely independent corporation, 
not connected with the teaching faculties of the 
University. ^ — 

Subscriptions may be sent to any of the above- 
mentioned, and will be gratefully acknowledged 
in The Hospital Bulletin and in Old Mary- 
land. 



THE FUND IS GROWING. 

The following contributions have been made 
to the endowment fund for the department of 
pathology to May i : 

Robinson bequest, in memory of Dr. 

Aloreau Forrest, class of 1826 $5000 00 

Dr. Gideon Timberlake 25 00 

Class of 1848, Dr. John J. R. Krozer. ... 50 00 

" 1873, Dr. Thomas A. Ashby. ... 100 00 

" 1873, Dr. David W. Bulluck.. . . 100 00 

1873, Dr. Robert Gerstell 5 00 

" 1873, Dr. Randolph Winslow.. . 100 00 

1882, Dr. J. Mason Hundley. . . 250 00 

1885, Dr. B.Merrill Hopkinson. 2500 

" 1900, Dr. Salvatore Demarco. . . 50 00 

" 1901, Dr. Nathan Winslow 50 00 

" 1902, Dr. Arthur M. Shipley. . . 250 00 

" 1903, Dr. Hugh W. Brent 25 00 

" 1905, Dr. Robert P. Bay 100 00 



$6130 00 



LIVING ALUMNI OF THE OLDER 
CLASSES. 

We would be pleased to learn the names and 
addresses of any other alunmi belonging to the 
following classes : 

John W. C. O'Neill, Gettysburg, Pa., 1844. 

John J. R. Krozer, Baltimore, :Md., 1848. 

R. Pinkney Blackistone, River Springs, Md., 
1849. 



54 



THE HOSPITAL BULLETIN 



H. R. Roland, Annapolis, Md., 1850. 
Henry M. Wilson, Baltimore, Md., 1850. 
Philip S. Field, Baltimore, Md., 1852. 
Jas. H. Jarrett, Towson, Md., 1852. 
Thos. B. Owings, Ellicott City, 1852. 
\Vm. G. Wilson, Shelbyville, 111., 1852. 
Wm. E. Magruder, Sandy Spring, Md., 1854. 
E. Tracy Bishop, Sniithsburg, Md., 1855. 
Joshua W. Hering, Westminster, Md., 1855. 
John D. Cronmiller, Laurel, Md., 1856. 
James H. Butler, Baltimore, Md., 1857. 
Benj. F. Price, Mt. Carmel, Md., 1857. 
J. Ford Thompson, Washington, D. C, 1857. 
Samuel C. Chew, Roland Park, Md., 1858. 
Nathaniel G. Keirle, Baltimore, Md., 1858. 
Edward F. :\Iilholland, Baltimore, Md., 1858. 
Somerset R. Waters, Watersville, Md., 1858. 
Theodore Cooke, Sr., Baltimore, Md., 1859. 
Robert A. Dodson, St. Michaels, Md., 1850. 
Ephraini Hopkins, Darlington, !Md., 1859. 
Jas. G. Linthicum, Baltimore, Md., 1859. 
Samuel Quinn, Pocomoke, Md., 1859. 
Benj. L. Smith, Madison. Md., 1859. 
Thomas P. Robinson, Flintstone, jMd.. 1859. 
James K. Waters, Thurmont, Md., 1859. 
Henrv L. Naylor, Pikesville, Md., i860. 



ABSTRACTS 



REMARKS ON MEDICAL ETHICS. 

Dr. Samuel T. Earle, class of 1870, has the fol- 
lowing remarks in the Bulletin of the Medical and 
Cliirurgical Faculty of Maryland on the above- 
mentioned subject : 

"It is with considerable hesitation that I ven- 
ture to open the discussion tonight on the subject 
of 'The Ethical Relations Which Should Exist 
Between the General Practitioner, the Surgeon 
and the Specialist' on account of the delicate na- 
ture of the subject and the difficulties attending 
their solution, yet the freriuent murmurings and 
general discontent that we hear whispered from so 
many sources compel us to open the subject for 
general discussion among the members of the pro- 
fession lest a disregard of such warnings should 
lead us to such an unhealthy condition of affairs 
in our profession as might bring to us the ])lush 
of shame. 

"Among such unwelcome conditions may be 
mentioned a division of fees and the attempt on 
the part of the general practitioner to do work for 



which he is unqualified and unequipped. Self- 
preservation is but a part of our nature, and it is 
only reasonable to suppose that a man who has 
honestly given the required time and application 
to acquire his license to practice medicine should 
expect to obtain a competent livelihood by this 
means, provided his eftorts are energetic and 
honest. 

"On the other hand, it is perfectly proper that 
the large field of medicine should be subdivided 
among general and special workers, because it is 
generally recognized that certain classes of this 
work can be better done by delegating it to spe- 
cial workers. These two propositions are readily 
conceded by all. 

"The problem which now demands a solution 
from us is the proper recognition and remunera- 
tion that each should receive for his portion of 
the work. With the rapid strides made by gen- 
eral surgery and its special branches, together 
with the readiness with which its brilliant results 
can be recognized by the laity, this branch of our 
profession has received much more recognition 
from the public and a willingness on their part 
to render much larger remuneration for such serv- 
ices than that of other departments which ma}' J 
have required more thought and study, but which ' 
have not been so readily appreciated by the public. 

"It is for the members of the profession who 
can appreciate the character and quality of the 
work of each one to determine what recognition 
and remuneration is due each. The man who does 1 
the preliminary work, and in many cases makes ' 
the diagnosis, but recognizes that a general sur- 
geon or a specialist can accomplish the cure far 
better than himself, is certainly entitled to more 
consideration in many cases than he has thus far 
received. When he is honest enough to make 
such a statement to his patient, and sends him to 
the surgeon or specialist for the relief of this 
special complaint, the surgeon or specialist should 
be equally honest and liberal in returning this pa- 
tient to his regular physician as soon as these 
special results are accomplished, with instruc- 
tions to report any further trouble of whatever 
nature to his regular physician, who is to deter- 
mine whether or not he shall again be sent to the 
specialist. Slioukl the case be one that does not 
come within the jurisdiction of the specialist to 
whom he was first referred, the latter should 
either refer him back to his regular physician or 
confer with his regular physician as to whom else 



THE HOSPITAL BULLETIN 



55 



he shall be referred whenever this is practicaljle. 
The surgeon or speciaHst should also see that hi, 
brother receives proper compensation for the work 
he has done, even at the risk of his not getting his 
regular fee for such special work, but his should 
all be done openly, with a statement to the patient 
of his regular charges for such special work, and 
that they shall only be exacted in full in case the 
patient is able to pay both the general and special 
charges. 

"It is best that we should discuss this subject 
freely among ourselves, but it can be settled satis- 
factorilv only by complying strictly with gentle- 
manly conduct and honesty. 

"I can probably make my position in this matter 
more clearly understood by quoting from Dr. H. 
C. \\'urdemann, Seattle, Wash., Nortlizcest Medi- 
cine. September, 1910. I fully agree with his 
views : 

" 'Professional fees are regulated by several 
factors, kind of services rendered, amount of time 
consumed, financial standing of the patient and 
the responsibility. There are no fixed fees for 
service, the only professional and legal require- 
ments being that they be reasonable and in ac- 
cord with the class of society to which the patient 
belongs. 

■■ 'The giving or acceptance of commissions to 
physicians (or other people) for sending patients 
is an unethical and dishonest act, wdiich has not 
been tolerated by true physicians from the days of 
antiquity. It is dishonest because the patient is 
deceived, and the collusion is more dishonorable 
than that of the condemned commission business 
between the doctor and the druggist, long 
frowned upon by both the profession and laity. 
It is a cowardly proceeding if either of the doc- 
tors is afraid to let the patient know for what he 
is paying that which he has an ethical and legal 
right to know. The medical profession is not a 
trade, and division of fees without knowledge of 
the patient would be degrading the whole profes- 
sion to the trade level. 

" 'You may have spent time in caring for or 
in accompanying a patient to the consultant's 
office and feel delicate about submitting a bill for 
it. \\'hy? That is pure cowardice; the laborer 
is worthy ni his hire. 

" 'On account of his financial condition the pa- 
tient may not be able to pay the usual fee of the 
consultant or surgeon, yet you feel that you are 
entitled to some payment for your services. The 



matter is easily arranged ; the patient has but to 
explain his circumstances, and the consultant 
should be willing to reduce his fees so that the 
family physician may get some payment ; but this 
all must be done with the full knowledge and con- 
sent of the patient. The consultant shotild be 
willing, when necessary, on account of the finan- 
cial condition of the patient, to reduce the bill 
enough, even to giving his services gratuitously, 
to allow him to pay the family doctor, but the 
specialist should not pay over part of his fee 
because tlie other is afraid to demand it of the 
patient. 

" 'The consultant should be willing to do any 
special work for what is a customary fee among 
specialists of proper standings for patients able 
to pay the same ; for others who can pay but little, 
for the proportion of the usual fee they may be 
able to give after paying for the general practi- 
tioner's services, and in cases unable to pay any- 
thing to cheerfully do the work without monetary 
recompense upon the physician's recommenda- 
tion : but he should not hire any medical 'barkers' 
to drum up trade. The strongest reason, aside 
from the ethics of the case, is that the specialist 
should value the esteem of the general profession 
more than business, which he could not retain if he 
abandoned ethics and customs followed since the 
days of Galen — yea, even from those of Escu- 
lapius.' " 



ITEMS 

Amongst our alumni located in North Carolin.T. 
are the following : 

Croft. 
Simril N. Henderson, class of 1894. 

D.\BNEV. 

Charles D. \\'yche, class of 1888. 

Davidson. 
John ^^'ilson INIacConnell, class of 1907. 

Deep Creek. 
John E. Hart, class of 1897. 

Duke. 
Augustus C. Boyles, class of 1897. 

Dunn. 
C. Hector Sexton, class of 1890. 

Durham. 
Archibald Cheatham, class of 1888. 
Robert T. Phelps, class of 1898. 
Calvin S. Hickes. class of 1904. 



56 



THE HOSPITAL BULLETIN 



Thomas A. Alann, class of 1903. 
Robert Alfred Moore, class of 1891. 
William Wade Olive, class of 1906. 
Rufus J. Teague, class of 1890. 

Edenton. 
Harry M. S. Cason, class of 1899. 

Elizabeth City. 
J. B. Grisgs, class of 1892. 
William James Lnmsden, class of 1869. 
Charles W. Sawyer, class of 1885. 
Herbert T. Walker, class of 1902. 

Elii City. 
Benjamin Franklin Barnes, class of 1902. 
Edwin G. JMoore, class of 1883. 

Elp.\so. 
Erastus G. Goodman, class of 1891. 

EVALIN. 

J. V. Williams, class of 1889. 

EVEEETTS. 

John Watkins Williams, class of 1906. 

Fair Bluff. 
Alva G. Floyd, class of 1885. 

Fairmont. 
J. P. Brown, class of 1883. 
Falkland. 
Jcnness Morrill, class of 1888. 

Fayetteville. 
Robinette B. Hayes, class of 1906. 
James Vance JMcGougan, class of 1893. 
T. Marshall West, class of 1908. 

Franklinton. 
Richard B. Henderson, class of 1884. 

Fuquay Springs. 
James A. Sexton, class of 1873. 

Gaston I A. 
Charles Edward Adams, class of 1878. 
Lucius Newton Glenn, class of 1897. 
Frank G. Wilson, class of 1896. 

Gibson. 
John Shaw Gibson, class of 1905. 

Goldsborough. 
Thomas ^Malcolm Bizzell, class of 1908. 
Richard E. Lee, class of 1896. 

Greensboro. 
Charles W. Banner, class of 1899. 
Louis N. Biirleyson, class of 1891. 
R. E. Dees, class of 1906. 
R. O. Dees, class of 1906. 
Julius J. Hilton, class of 1886 



Arthur E. Ledbetter, class of 1888. 
Arthur Ogburn Spoon, class of 1908. 
J. Pinkney Turner, class of 1896. 
Buxton B. Williams, class of 1883. 

Greenville. 
Louis C. Skinner, class of 1901. 

Grifton. 
Walter W. Dawson, class of 1897. 
William Cobb Whitfield, class of 1884. 

Gri-meslaxd. 
Claude i\L Jones, class of 1892. 

Grissom. 
Ginnada T. Sikes, class of 1883. 

Hamilton. 
Benjamin L. Long, class of 1881. 

Harrisburg. 
James C. Black, class of 1886. 

Haw River. 
L. W. McPherson, class of 1903. 

Henderson. 
Edwin F. Fenner, class of 1905. 
Hendersonville. 
James L. Egerton, class of 1877. 
Columbus Few, class of 1875. 

Hertford. 
Robert Walker Smith, class of 1892. 

Hickory. 
\^'illiam H. Nicholson, class of 1889. 
Benjamin Franklin Whitside, class of 1877. 

HiGHPOINT. 

William M. Jones, Jr., class of 1903. 

HUNTERSVILLE. 

William W. Craven, class of 1903. 
\\"illiam St. Clair Davidson, class of 1887. 

Jacksonville. 
E. L. Cox, class of 1889. 

Jamestown. 
John Edward Foscue, class of 190T. 

Keenansville. 
Albert Franklin Williams, class of 1901. 

Kernersville. 
Romulus L. Carlton, class of 1906. 

Kerr. 
Charles S. Kerr, class of 1868. 

Kinston. 
William F. Hargrove, class of 1901. 
Richard H. Temple, class of 1884. 



THE HOSPITAL BULLETIN 



57 



Ladonia. 
K. Thompson, class of i86S. 
Jolin \\'. B. Smithwich, class of 1895. 

Lakk Landixg. 
James Emory Mann, class of 1907. 

Laukinburg. 
Peter John, class of 1897. 
W. D. Jones, class of 190S. 

Lenoir. 
Wm. P. Ivey, class of 18S3. 

Lewiston. 
Wavland L. Mitchell, class of 1895. 

Lexington. 
E. J. Buchanan, class of 1892. 

LlLESVILI.E. 

J. Edwin Kerr, class of 1897. 

LiNCOLNTON. 

Robert William Petrie, class of 1903. 

Lin WOOD. 
James Edwin Cathell, class of 1899. 

Littleton. 
Willis Allston, Jr., class of 1903. 
B. Ray Browning, class of 1891. 

LOUISBURG. 

Emmitt H. Bohbitts, class of 1877. 

Lowell. 
George R. Patrick, class of 1879. 

LUMBERTON. 

John Knox, Jr., class of 1907. 
Allen ^IcLean, class of 1908. 
Richard Gregory Rozier, class of 1899. 

Maiden. 
Jerry C. Whitside, class of 1877. 

I\Lanteo. 
Woodson P.. Fearing, class of 1881. 



The recent newspapers have published the ])i.>r- 
trait of Dr. John J. R. Krozer, class of 1848, whu 
is said to be the oldest living graduate in Balti- 
more of the University of Maryland Medical De- 
partment. Dr. Krozer has been practicing for O3 
years, and is 84 years of age. Of himself he has 
the following to say: 

"I was born in Elizabeth City, N. €.. and 
raised everywhere. When I was five years old 
my father died of the Asiatic cholera in its firs: 
invasion of this cOuntrv. and mv niolher moved 



with me to Virginia. When 15 years old I en- 
tered the United States Marine Hospital, and was 
there for four years before I entered the Llniver- 
sity. In those days we doctors started early and 
worked hard to get our degrees. Two years' 
studv under a physician was then required of a 
student before he was allowed to enter the Uni- 
versity, but its diploma, together with that of 
the University of Pennsylvania, was even then 
recognized in France, where medicine was at its 
highest. Those two universities were the only 
chartered schools in the LTnited States the degree.? 
of which were recognized abroad." 

Dr. Krozer was born August 30, 1827, and was 
the son of Dr. John Krozer. He was educated at 
the Military Academy of Portsmouth, Ya., en- 
tering at the age of 15 the L'nited States Marine 
Hospital, above mentioned, and later the Univer- 
sit}' of Maryland, from which he graduated in 
1848. He resides at 662 West Lexington street, 
Baltimore. 

Dr. Krozer has in his office an excellent engrav- 
ing of the United States Marine Hospital at Ports- 
mouth, in which he began the study of medicine 
69 years ago. He has owned it since 1855, when 
it was engraved b}' Caspar Bohn of Washington. 
On it is depicted the old sidewheeler Herald of 
the Bay Line, which was the twin ship of the Geor- 
gia, both of which have long since gone to the 
junk pile. He was also on board the LTnited 
States frigate .St. Lawrence when she was 
launched in 1845 from the navy-yard at Ports- 
mouth. She was built of wood, and was a three- 
masted sailing vessel. 

The next commencement of the university, 
which he will attend, is the sixty-fourth which he 
has seen since he entered on (.)ctober 15, 1846. 



A portrait of Dr. James H. Jarrett has been 
placed in the hall of the Medical and Chirurgical 
Faculty of Maryland, 121 1 Cathedral street, Bal- 
timore, by the Baltimore County Medical Asso- 
ciation. The Sun published the portrait of Dr. 
Jarrett, and gave the following account of his 
life: 

Dr. Jarrett was born February 24, 1832, in 
Harford county, and is of English descent. 

The doctor's grandfather, Jesse Jarrett. was 
born in Harford county, where he became a lead- 
ing farmer. He had a son, Asbury, who was a 
soldier in the \\'ar of 181 2, and later became a 
l)iominent merchant of lialtimore. .\nother son. 



58 



THE HOSPITAL BULLETIN 



Jesse, was a farmer in Harford county. The only 
son of Jesse Jarrett by his second marriage was 
Luther M. Jarrett, who was Dr. Jarrett's father. 
He was born in Harford county in 1804, and was 
a successful farmer and merchant. About 1837 
he platted the village of Jarrettsville, which was 
named in his honor. Lie was one of the leading 
Democratic politicians in Harford county, and rep- 
resented his district two terms in the Legislature, 
and held several positions of trust and honor. 

In 1848 Dr. James H. Jarrett entered Dickinson 
College, where he completed his education, and 
entered the medical department of the University 
of ^Maryland. He graduated in 1852, and prac- 
ticed for nine years at Jarrettsville. At the break- 
ing out of the Civil War every member of the 
Jarrett family was an advocate of the Confederacy 
except the doctor, and when he announced that 
he was in favor of the L'uion and intended to 
enter the Union Anny his course was bitterly 
opposed by his family. 

Undaunted by opposition. Dr. Jarrett at once 
entered the Purnell Legion, organized by Col. 
William H. Purnell, as an assistant surgeon, and 
after serving a year was promoted to surgeon of 
the Seventh Maryland Infantry, organized and 
commanded by Col. E. H. Webster of Llarford 
county, and attached to the Army of the Potomac. 
His service was on the Eastern Shore of Virginia, 
and he was within hearing distance of the guns 
at the battle between the Monitor and the .Merri- 
niac. He was at the headquarters of Captain 
Duvall, at Cherrystone, when a messenger came 
up and announced that he wished to send word 
to Washington of the battle. Captain Duvall fur- 
nished an orderly and horse to take the mes- 
senger to Eastville to telegraph to Washington. 

Finally his ardous duties and overexertion 
caused his health to break down, and in 1864 he 
resigned on account of disability. While in the 
army he became acquainted with many of the lead- 
ing residents of Towson and vicinity, and so 
strongly was he attached to them that in 1865 he 
decided to make his home at Towson, and pur- 
chasetl property there. When he started at Tow- 
son the leading physician was the late Dr. Jack- 
son Pii)er. 

In 1855 and 1856, as a Whig, Dr. Jarrett served 
in the State Legislature from Harford county. 
He was a member of the State convention which 
nominated Thomas Holliday Hicks for Governor. 
There was a three-cornered contest between 



James Jj. Recaud, William H. Purnell and Hicks. 
Dr. Jarrett favored Purnell, but on the last ballot 
changed to Hicks, and thereby made him Gov- 
ernor. 

While his family w'ere well known as Demo- 
crats, Dr. Jarrett cast his lot with the Republican 
party in i860, and has voted the ticket ever since. 
At the close of the Civil War he became the public 
storekeeper at the custom-house, and held the 
position for four years. Lender President Arthur 
he was made a member of the United States Pen- 
sion Examining Board, a position held at present 
by his son. Dr. Harry S. Jarrett. 

Governor Lowndes made Dr. Jarrett one of a 
commission of three to compile and publish a 
record of the Union soldiers of Maryland during 
the Civil War. Dr. Jarrett was in Baltimore 
April 19, 1861, during the riot. 

In 1852 Dr. Jarrett married Miss Julia A. 
Spottswood, daughter of William Spottswood of 
Carlisle, Pa., who died some years ago. He has a 
son. Dr. Harry S. Jarrett, who is a graduate of 
the College of Physicians and Surgeons, Balti- 
more, and two daughters, Mrs. William A. Lee 
and Miss Julia Jarrett of Towson. Mr. William 
B. Jarrett of the Internal Revenue Service is a 
brother. 



Dr. Randolph Winslow, class of 1873, has re- 
ceived the following letter from Dr. Charles Ed- 
ward Scholl of Camden, Ind., a classmate. The 
]\Iichael referred to is Dr. J. Edwin Michael of 
the same class, now deceased. The other members 
of this class referred to are Drs. Thomas A. 
Ashby of Baltimore ; John H. Rehberger, also of 
Baltimore : Truman E. Fairall of Tecumseh, Xeb. ; 
James A. Sexton of Fuquay Springs. X. C, and 
David William Bullock of Wilmington. X. C. 

The letter reads : 

Camden, Ind., April 13, 191 T. 

Randolph Winslow, M.D., 

Baltimore, Md. : 

Dear Doctor — I received your letter of the 13th 
inst. yesterday, and to say that I was surprised 
and delighted but half expresses my true feeling. 
My wife and I early last fall planned to spend 
the winter in Baltimore, and had even gone so far 
in carrying out our -plans as to engage rooms on 
West Fayette street, but, unfortunately for us, my 
presence here was required, and we were compelled 



THE HOSPITAL BULLETIN 



sy 



to give up the visit altoL;etIier. I wanted to look 
up old friends in your city, and to renew old 
acquaintances. I had often wondered what had 
become of the old boys of the class of "".v You 
were the only member of our class that I could 
locate, as you were the last one — you and Michael 
— that I had met, and one of the professors of 
the School of Medicine of the University of In- 
diana told me that he had met you at Chicago or 
Washington, I have forgotten which. Your kind 
letter gave me just the information I wanted. 
Some of them very familiar ; some I recalled with 
an effort, as I have been so long out of touch with 
everyone and everything connected with the old 
University. I came here nearly 36 years ago, 
and have had a very busy life, with all the hard- 
ships and pleasures incident to a country practice, 
imd now that I am growing old can say, with all 
others in this life, my reward has been all that I 
deserved. One of the greatest pleasures your let- 
ter afforded me was to run over the list of sur- 
vivors of our class, to recall their peculiarities or 
characteristics as I remember them. Why, Doctor, 
it was almost like meeting each one again ! Ashby, 
Rehberger, Fairall. Sexton, Bullock, and Michael, 
cut down in his prime ; they were a fine lot of fel- 
lows ! You ask why I made myself so scarce, 
and the reply comes naturally enough. New 
scenes, new associates, new duties mean a new 
place in life. I have visited ^Maryland man}' times, 
and several times passed through Baltimore, but 
each time was impressed with the fact that I had 
lost my old place there by my removal, and my 
place was here. If I live I am coming back for h 
good long visit — perhaps next winter — and then I 
will give myself time enough to hunt up and meet 
all the old friends. Remember me kindly to all 
the class in Baltimore, and accept my thanks for 
your kind letter, and best wishes for you and 
yours. I am, 

Very truly yours, 

C. E. SCHOLL. 



The follow'ing members of the class of 191 1 
have secured appointments as follows on the staffs 
of Baltimore hospitals for the ensuing j-ear : At 
Bayview — Joseph Enloe Thomas of South Caro- 
lina. Paul Pressly McCain of South Carolina, 
William Clinton Marett of South Carolina, Her- 
bert Augustus Codington of Georgia and Grafton 
Dent Townshend of Maryland as assistant resi- 



dent jihysicians ; Raymond Garrison Husse_\ of 
North Carolina as chief physician of the tubercu- 
losis department; Burt Jacob Asper of Pennsyl- 
vania as chief physician of the department of men- 
tal diseases. At the Hebrew Hospital — Charles 
Lewis Schmidt of ^laryland and Isaac M. Slacks, 
also of ^laryland, assistant resident physicians, 
and Isadore Hirschman of Maryland as resident 
pathologist. At the Church Home and Infirmary 
— George Y. Massenburg, resident physician. 



Miss T^Iary Constance Wiggin of New York, 
University Hospital Training School for Nurses, 
class of 1910, has received an appointment in the 
United States Naval Nursing Corps. 



BIRTHS 



Dr. Allen Kerr Bond, class of 1882, and Mrs. 
Bond are rejoicing over the birth of a daughter, 
Christiana Birckhead Bond, on March 17. 191 1. 



DEATHS 



Dr. John Richard Thomas Reeves, class of 
1858, died at his home in Chaptico, Md., April 14, 
1911. 

Dr. Reeves was born at Charlotte Hall, St. 
Mary's county, Maryland, October 8, 1832. He 
was the son of Thomas Courtney Reeves and 
Mary Elizabeth Edwards. His early education 
was received at Charlotte Hall Acadeni\-, For 
some years after graduation he taught in private 
families, afterwards matriculating at the Univer- 
sity of Maryland. Dr. Reeves was at one time 
tutor in the family of Governor Samuel Sprigg. 

Dr. Reeves was devoted to his profession, and 
though during the last few years of his life he was 
not engaged in active practice, he never lost in- 
terest in the work of his fellow-practitioners. 

He married on October 16, i860, Miss Eliza- 
beth Ellen Hayden, who died in 1899. Dr. Reeves 
is survived by six sons — Thomas Garner. George 
Richard, John Courtney, Samuel Sprigg. \\'illiam 
Pinkney and John R. T. Reeves — and one daugh- 
ter. Miss Bessie C. Reeves. 

One incident of Dr. Reeves" life which he loved 
to relate was a trip he made to Gettysburg im- 
mediately after the great battle there in order to 



6o 



THE HOSPITAL. BULLETIN 



render medical aid to a mortally-wounded brother- 
in-law. After some difficulty in getting through 
the lines he finally succeeded in reaching the ob~ 
iect of his cjuest. While there a wounded Con- 
federate soldier, who thought he was about to 
die, handed his sword to Dr. Reeves, as he did not 
wish it to fall into the hands of the L'nion sol- 
diers. Dr. Reeves managed to get the sword 
home without being detected, and a full 20 years 
after met again by a round-about method the 
owner of it, who was able to identify the sword 
by the blood spots on the handle, still perceptible. 



Dr. Jacob Dimmitt Xorris, class of 1878, died at 
iiis home, 1221 West Fayette street, at 12.30 o'clock 
April 24, 191 1, of heart trouble. He had been in 
I>oor health for several weeks. Dr. Xorris Vias 
born in Belair, ]Md.. August i, 1854. He was the 
son of Lloyd A. Norris and Alary A. Stansbury 
Norris, and a descendant of Sir John Xorris, an 
admiral in the British Navy. He received his 
earlier education at the Springfield Institute, near 
Fallstiin. ^^■hen Dr. Xorris was 19 years of age 
the Civil ^\'ar broke out. He entered the Con- 
federate Army at Nashville, and fought through- 
out the Civil War.' At the close of the war he 
went to St. Louis, Mo., and later to Eldorado Bar, 
N. M., and still later to Helena, Mont., where 
he engaged in mining. In this, however, he was 
unsuccessful, and later took a position on a ranch. 
This, also, was not to his taste. He then went 
to Walla Walla, Wash., and studied medicine for 
a year with Dr. J. C. Blacklock. He then started 
East on horseback, in 1876, coming as far as St. 
Louis in that manner and by train the rest of the 
way to Baltiiuore. A year later he entered the 
L'niversitv of Maryland, graduating in two years' 
time. He received an appointment as vaccine 
phvsician by Alayor Latrobe. and was reappointed 
1)\- Mavor Hodges, who also appointed him cmi- 
niissioner of Franklin Square. President tirover 
Cleveland, during his second term, appointed Dr. 
Xorris as president of the second Pension Board 
of I'.altimore. He was one of the first luen to join 
the Fourth Regiment of the Maryland National 
Ciuard. and at the time of his death was chief 
surgeon, ranking as major. Fie accompanied the 
regiment on several trips, notably the one when 
they were ordered out to quell the riots in the 
Frostburg (Md.) mining districts. During the 
administration of Mayor Thomas Hayes Dr. 



Norris was elected to the City Council from the 
Twent}-first \\'ard. 

He married in 1881 Aliss Mary Eunice \\'ar- 
field of Frederick county, who survives him. He 
also leaves two daughters — Misses Hester and 
Jessie Xorris, and one son, Dr. Lester D. Xorris, 
class of 1908, surgeon for the Baltimore & Ohio 
Railroad at Wheeling, W. ^'a. The Masonic 
order, of which Dr. Norris was a member, had 
charge of the funeral services. Interment was in 
Lorraine Cemeterv. 



LABORATORY REPORT OF THE UXI- 
\ERSITY HOSPITAL. 

AIoxTH OF April. 
Blood E.vaniiiiatioiis. 

Leucocyte Counts 156 

Erythrocyte Counts 103 

Diflferential Leucocyte Counts 7 

Flemoglobin Determinations 103 

Smears for Malarial Parasites 8 

Blood Cultures 2 

Wasserman Tests 18 

Widal Tests 5 

402 

Urine E.vaniiiiatioiis. 

Routine Urinalysis { chemical and micro- 
scopic ) 388 

Total estimation for Urea 2 

Total estimation for Albumen 4 

Total estimation for Sugar 2 

396 

Miscellaneous. 

Gastric Contents (chemical and micro- 
scopic ) II 

Feces (macroscopical, microscopical and 

some cases chemical examination) ... 12 

Sputum Examination 18 

Bacteriological Cultures and Smears 

(from operative cases) 8 

Examination of Spinal Fluid 2 

Section of Tissue for Alicroscopical E.x- 

amination 32 

Autopsies 4 

87 

Total 885 

Dr. J. L. HiRsii. 
Dr. H. J. j\I.\LDEis, 
Dr. R. Dii.ler. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., JUNE IS, 1911. 



No. 4 



ADDRESS OF DR. HARVEY W. WILEY, 
DELIVERED AT THE LYRIC THEA- 
TER JUNE I, 1911, at 4.15 P. M., ON 
THE OCCASION OF THE GRADUAT- 
ING EXERCISES OF THE UNIVER- 
SITY OF ]\IARYLAND. 



Members of the Faculty of the University of 
Maryland, Students and Graduates of the 
University: 

As a farmer I am struck with this fact today — 
that there is one crop in this country that never 
fails, no matter liow dry it may be nor how late 
the frost may come in the spring, nor how apa- 
thetic a husbandman may prove himself to be, the 
crop of bachelors and the crop of doctors never 
fails us. But it is, I suppose, a mark of the won- 
derful prosperity of the country that this crop 
goes on, ever increasing in volume. As I saw 
this great concourse of gowned young men and 
one or two young women — for I see you have a 
sprinkling of a competition which you have got 
to look out for in the future — I wondered where 
you are going to find places ; if you are all going 
to get jobs. And remember, that there are other 
universities besides that of Maryland in this coun- 
try. I have been going now for about two weeks 
almost every day addressing people who are grad- 
uating, so to speak, so I have seen a great many 
of them, and I hope that the pleasure which I get 
upon looking into the faces of young graduates 
may never be denied me as long as I live and have 
a voice. I hope that the institutions of this coun- 
try will continue to ask me to come to their com- 
mencements, because I can assure you that great 
as your pleasure is in receiving your diploma, it 
gives me even greater pleasure to look into the 
faces of these young people who are to be the 



arbiters of the destinies of this country. So I am 
glad to see you to-day; I am glad to see such 
numbers of you, so many who have completed the 
courses assigned and who are ready, I suppose, 
to begin the more active duties of life. Some of 
you are unfitted for that yet, because I see some 
are only bachelors of arts or bachelors of science. 
Now, with what profound pity you must look 
down upon a bachelor of arts, you who bear the 
dignity of doctor of medicine or of law ! The one 
is only a preparation for the degree which you 
have already received, but let me tell you bach- 
elors of science and bachelors of arts that there is 
not so very much difference sometimes, after all, 
between the amount of learning which a bachelor 
of science or of arts may have and that which is 
borne by a doctor of medicine or a bachelor of 
law. I have been opposed for a great many 
years — but I do not want you to draw from this 
any reflection upon you young bachelors or doc- 
tors of medicine — but I have long been of the 
opinion that it is not proper to give the degree of 
"Doctor of Medicine" to a graduate in medicine, 
because the word "doctor" does not mean a physi- 
cian any longer. It never did; although in this 
country when we speak of a man as a doctor we 
associate the idea with the practice of medicine 
in some way in one form or another. The word 
"doctor" does not have anything to do with medi- 
cine necessarily. The term "doctor" means one 
who is learned, one who has approved himself as 
a man of learning. I think the English custom 
is a great deal better. It is a long while after 
graduation in medicine before the English physi- 
cian can assume the title of "doctor." But that 
has nothing to do with the case today. You are 
doctors, or soon are to be, and I do not suppose 
you ought to be deprived of that pleasure, but it 
is a long while before you can get to be doctors 
of laws, and some of you never will. I was almost 



62 



THE HOSPITAL BULLETIN 



as old as I am now before 1 got to be a doctor of 
laws. You do not have to be a lawyer to be a doc- 
tor of laws. But the term doctor, I claim, should 
be reserved to give to a man after he has proved 
himself in the active field of service. In the old 
times, and probably yet, there was a fiction which 
said : "The king can do no wrong." That is to 
say, that there is a divinity that doth hedge about 
the king which prevents him from doing a wrong. 
That naturally goes with the idea of the divine 
right to rule. And in those olden days, too, in the 
feudal times, the lord or baron was supposed to 
be the protector of his people. They had no other 
protector except their lord. If he did not look 
after them they had nobody to look after them. 
And hence there came to be associated with the 
lord of the realm, the baron of the realm, an idea 
of justice or protection and of support among 
his people, and hence when this title was given 
to the lord of the realm, as it usually was, he be- 
came the lord or the aristocrat or noble of the 
province. If he was the right kind of man — and 
being a man he generally was the right kind of 
man, because most men are — he looked out for 
and protected his people. If you have studied 
Greek you will know that the term "aristocrat" 
means the rule of the best, agatlws being the 
Greek for "good," and aristos being the superla- 
tive. I mention this because it is about 40 years 
since I studied Greek, and I want you to under- 
stand that I have not forgotten it. These aris- 
tocrats all looked after the people and protecteil 
their rights in those early days, and there- 
fore there came into existence this idea which 
the French have so beautifully expressed by the 
phrase noblesse oblige. The noble, the high posi- 
tion imposes an obligation, in other words, upon 
the men who have achieved it. So I say to-day 
that the distinction of receiving a diploma from 
this ancient and honorable University imposes 
upon each one of you an obligation, an obligation 
as the minister has so beautifully said in his 
prayer, to serve humanity. And let me tell you 
that the only good you will ever get out of 
your diploma will be in proportion as you real- 
ize the obligation it imi)oses upon you. To 
be sure, the old diploma.s — and I suppose the 
new ones also — used to read in very bad Latin 
that you were admitted to all the rights and privi- 
leges of the academy, but in the olden times they 
added to it and also all the duties thereunto per- 
taining. This is not a mere admission to a privi- 



lege, but it is an admission to a privilege on the 
condition that the duty which is attached to that 
privilege is performed. 

So I am going to speak to you today on that 
idea of noblesse oblige. The obligation which 
graduation imposes upon each one of you in the 
particular course of duty which you are to per- 
form is embodied in this idea of noblesse oblige. 
Now, in a graduation of this kind, where all 
the schools are represented, I can hardly select 
any particular one to whom to address my re- 
marks, and so I am going to make them as general 
as possible, so that all may be included. 

Now. let us begin with this distinction — that 
the difference between the man who bears a 
diploma and the one who does not is one of broad- 
ened intellectual conception. The man with a 
diploma ought to have a broader view of things 
than the man who has not a diploma. Sometimes 
that is not the case. Some quite learned men 
have never been to college, and some who have 
been through colleges and universities and who 
have diplomas are pretty narrow, I have found, 
in their views, and the principle which I enun- 
ciate, then, is a general one, and does not al- 
ways apply. But if you do not have a broader 
view of things, then your course in this institution 
has been in vain in so far as you are concerned. If 
you have not knowledge and a knowledge how 
to apply knowledge, which the man who does not 
bear the diploma has not got, then you have not 
done your duty in this institution or the institu- 
tion has not done its duty to you — one of the two. 
Now, having this increased power, having become 
a nobleman in the true sense of the word, there 
is imposed upon you that obligation of noblesse 
oblige. What are some of the things that are 
imposed upon you ? In the first place, you should 
become good citizens of this country. That is the 
first thing you ought to look out for — to see that 
you have the right view of public affairs. Now, 
I am not going to give any tirade on politics, only 
to say this — that we are too apt in this country, 
all of us, to go blindly in our political creed. We 
all have been brought up, perhaps — I know most 
of us have — to some particular religious creed, 
and we are ver\' apt, when we grow up, to follow 
that creed. Sometimes we get away from all 
creeds, which is an unfortunate thing. It is better 
to follow the one you were brought up in than to 
have none at all, even if that be faulty. And the 
same is true with politics. You ought to have 



J 



THE HOSPITAL BULLETIN 



63 



some politics, and if you haven't time to have some 
of your own, you ought to take those of your 
father, if you have faith and confidence enough in 
your father's politics, and I trust you have. If 
you haven't time to study them for yourself, then 
follow along in the line in which you have been 
brought up. But it is very hard, indeed, to break 
away from those moorings, and yet the duty of 
ever}' young man and every young woman is to 
have some politics. I say "young woman" be- 
cause you are going to vote very soon. I see you 
back there in the audience ; you are going to have 
the ballot just as sure as I stand here, and you are 
going to take part in the civic uplift of this coun- 
try, and it is the duty of every young man and 
every young woman to think about political 
affairs, and not to be blindly led by your leaders, 
whoever they may be. This is a country of free 
thought. We have not had any restriction placed 
upon a man's thoughts and their expressions un- 
less they tend to disrupt society. As long as your 
thoughts are right, as long as they are for the 
benefit of mankind, you have your right to your 
thoughts and your right to your religion and your 
right to your politics and your right to your phi- 
losophy and your right to your medical profession, 
or whatever you want, and it is your duty to be 
an independent thinker on matters referring to 
the welfare of the State, whether it be of the city 
or State or the nation. So I see a development 
in this country, and largely among college and 
university-bred men, toward that spirit of political 
independence which means so much for the wel- 
fare of our country, and so much for the perpetua- 
tion of our free institutions. Now, let me tell you 
young people that we are entering upon an age 
of ferments ; the whole civic body is teeming with 
those organisms which produce the fermentation 
of the civic spirit, and we are having developed 
in this country dangerous tendencies as a result, 
and as a natural result, of the condition of atf'airs 
which exist in this country today. You cannot 
expect the people of this country to sit quietly 
by and see all the wealth of this great nation in a 
few hands. There must be something wrong 
when conditions of that kind prevail. Now, how 
are those conditions to be met? I say by philo- 
sophical inquiry, b)' a judicial spirit of inquiry, 
and not by mob and force and violence, as those 
conditions have been met in other countries, and 
will be met in this country if they are not met in 
some other way. Therefore, I say the solution 



of these great problems of socialism and anarchy 
and the rights of the common people and the 
rights of the workmen and the housing of the 
workmen and all Ihiise things which work for 
public sanitation and welfare and civic uplift 
have got to be solved by philosophical inquiry and 
a judicial disi)Osition of the mind. And it is the 
educated people of this country who are going to 
solve those problems ; the graduates of our univer- 
sities and of our colleges are to be the leaders in 
this, and you as citizens will have to face these 
problems in the near future. They are upon us 
now, and you have to act wisely and well in order 
that their solution may be a proper one. We do 
not want to see this country precipitated into the 
throes of a revolution because the proletariat 
is deprived of its rights. The man who is born 
in this country has the right to live and the right 
to earn his living and the right to work, and the 
right to receive the wages for his work, and 
every time that a dollar is improperly diverted to 
a coffer where it does not belong, just that mo- 
ment one dollar is taken from what the people of 
this country should have as a common inheritance. 
You have read Henry George and his theories of 
the land. Nobody owns land in this country. We 
all say we own land, and think we do, but there is 
not a man in this house, nor in any part of this 
country, who owns a foot of land. He holds it 
by the sufferance of the public, and the State can 
come in and take every foot of land that he owns 
to-day if it wants to. Why do you have to pay 
taxes on things you own? Because you do not 
own them ; if you did,, nobody would have any 
right in them at all. And we recognize the right 
of taxation and the right of eminent domain and 
the right which every State had to take not only 
the property, but the lives of its citizens for the 
public service. Just think for a moment, then, that 
you are not independent ; you are not standing 
alone, but you owe your property, your service 
and your lives to your country, and hence as citi- 
zens this sense of obligation, this noblesse oblige, 
rests upon you to become good citizen^. 

Then you want to make good husbands and 
fathers. And while I believe in the rights of 
women, that a woman has every right in the 
world that a man has, she has the right to vote, 
she has the right to earn her own living and she 
has the right to enter any profession she chooses 
to enter; but the woman's sphere is not alone in 
professional life ; it is as a mother and in the 



64 



THE HOSPITAL BULLETIN 



home, and there is only work enough in this coun- 
try for half of the grown people to do ; even if 
there were not, I would not want to see the 
women do the work ; I do not want to live in a 
country where the men sit in idleness and the 
women do the work, because, while a woman can 
adorn an idle chair, a man cannot. At the same 
time I would not deny any woman of this broad 
land a single right that I possess. She has a right 
to her own views in politics, she has a right to 
own property ; just as much as anybody can own 
property ; she has a right to rule her husband if 
she can — and most of them can — and she has a 
right to vote, and she has a right to be a physi- 
cian, and also a minister of the gospel and a citi- 
zen of this great republic, the highest honor of all. 
But with those rights — and in this it is the same 
as with the diploma — go the duties of women, 
and the duty of the woman is at the home, to be 
the mother. Tliat is her duty. Every right has 
a duty imposed with it, every single one. No 
man ought to claim any protection under the laws 
of his country who does not give some service 
to that country. The right of protection under 
the law rests wholly upon the duty which citizens 
render to the State. So we cannot claim that pro- 
tection unless we render that service. 

Then again, you young people have a duty 
which you have already performed to a large ex- 
tent, and that is in a preparation for this service 
which you propose to render. You have already, 
by passing the examinations and receiving the 
approval of your faculties, shown that you have 
prepared yourselves for the several duties which 
you are ])roposing to undertake. But do not fall 
into this error of thinking that the period of 
preparation and study is past. It is only begin- 
ning. You have only fabricated the implement up 
to the present time, the plow which you are to 
use in the cultivation of the field, and I do not care 
how skilful you are in theories, it does not neces- 
sarily spell success. I could sit down, if I knew 
how, and teach a man how to make a watch, and 
tell him how every single part of that watch was 
to be made, what size it should be and how it should 
be put together, but I would not like to trust that 
man to make a chronometer to run the universe 
by the first time he attempted it. He would make 
a sorry spectacle of it. Once I heard a story of 
an eminent specialist, an oculist, who was compli- 
mented on his skill in being able to save the sight 
of the eyes. He saved the sight in cases that were 



almost hopeless, and when complimented upon 
his skill he said : "Yes, I am skilful ; I can do 
these things; I can operate upon an eye with the 
greatest precision and restore apparently a vision 
that has vanished and prevent the destruction of 
that which seems to be going," but, he says, "I 
destroyed a bushel of eyes before I learned how 
to save one." Now, it is hard on the people who 
have the bushel of eyes. I expect it is going to 
be hard on some of the sick people in this country 
when they first fall into the hands of these young 
doctors, and hard on some of the clients who go 
before the courts represented by some of these 
}Oung lawyers. I fear they will be mulcted more 
heavily than they should when these young law- 
yers take hold of them. And I expect that many 
a tooth will ache that ought to be in placid retire- 
ment when these dentists get hold of them, and 
many a person, I fear, may have qualms in his 
stomach when the young pharmacist first pre- 
scribes for him. 

They tell a story of a man who had a lawyer 
who was very skilful. His client knew he was 
guilty and that he was going to be convicted. It 
was a civil case, so he did not have to be in court 
at the time. So the lawyer presented his case 
to the jury, and much to the lawyer's surprise the 
jury brought in a verdict of not guilty. He tele- 
graphed his client, "Justice has been done," and 
he received immediately a repl\- by telegram, say- 
ing, "Appeal at once." 

A mother once called in the old-fashioned 
"root and yarb" doctor for her boy, who was 
suffering with chills and fever. Now, I was born 
and brought up in Indiana, and I know what the 
"ager" is. A man was not a respectable citizen 
in that State unless he had an "ager-cake" as big 
as a bread basket. It was his title to nobility. 
The mother called in this old doctor, as I said, 
who prescribed for the boy. He took from his 
stock of herbs one of the roots, and he scraped 
it very carefully and put it in a glass and poured 
hot water on it and set it to one side. Then 
he scraped another piece from the same root 
and put it in another glass and poured hot water 
on it and set it to one side. Then he said to the 
mother: "When the boy has a chill you give 
him the first preparation, and when he has fever 
you give him the second one." "But," she said, 
"you took those botli from the same root, didn't 
you?" "Ah, yes, I did, but did you notice that I j 
scraped the first one up? That is high-cocka- ' 



scraper 



i 



THE HOSPITAL BULLETIN 



liiruin. And I scraped the second one one down — 
this is lo-cockahighrum." 

Now, I fear that much of the Ijeginning practice 
of the young physician will be of the high-cocka- 
lorum and the lo-cockahighrum stripe, and I say 
it is hard on those persons who lost the bushel 
of eyes in order that you may become skilful, but 
we have to take these chances in this world, and if 
we are brave enough to employ the young physi- 
cian or the young dentist or the young lawyer, 
we at least confer a service on those who come 
after us. 

Therefore, I say that the preparation or acquir- 
ing of the skill which you have largely accom- 
plished must be supplemented by its actual prac- 
tice, and that is where the judgment, the intel- 
ligence and the good sense — what we used to 
call "horse sense" (I do not know why they 
called it that, because I have seen some horses 
that have less sense than any human beings I ever 
saw), but the good horse sense of the individual, 
his individuality, his power of discrimination — 
come into use, and it makes a success of one man, 
and the lack of it makes a failure of another. 
Now, you are not all going to succeed. I am 
not going to specify those of you who are going 
to fail, so you need not take it personally. But 
here there are 210 graduates, I may say, and at 
least 10 of those are going to make failures of 
life. You can draw lots, all of you, to find out 
who they are, because I cannot tell you to-day 
which ones they are, but partly it will be the re- 
sult of environment in which they are placed, 
and largely it will be the result of the subject 
himself. There are some people who would be 
hungry if you were to turn them loose in a ban- 
quet hall filled with all the best things to eat in 
the world, and if you were to tell them to help 
themselves they would not know how to eat. 
There are some people who would fail under the 
most favorable circumstances for success. There 
are others who will succeed where the environ- 
ment seems almost hopeless. And I tell you that 
one of the principles which is the most impor- 
tant in this respect is wise patience. The man 
who will calmly wait under difficulties, under 
stress, under hardships, under privations, feel- 
ing that he has the stuff in him to make a success, 
and that he will succeed if he just keeps on, that 
man is almost certain to succeed, almost certain, 
I say. Yet, it is one of the hardest things in the 
world to teach a person the faculty of waiting. 



The young man wants to bound at once into suc- 
cess. He has had four or six or eight years' 
study in preparing for life, and now he expects 
in one year to make a reputation and a name for 
himself, and to make an income. Now, that is 
impossible, except in rare instances, at the present 
time, so the man who patiently waits, and who 
works while he waits and never gives up, never 
gives up his purposes, holds to the one purpose, 
is bound to succeed. But, young men, you are 
never going to succeed by trying this thing to-day 
and that thing tomorrow. You want to try this 
thing to-day and tomorrow and all the time when 
you make up your mind to try it. Never give up. 
I never saw a man yet who got into a habit 
of going from pillar to post trying this and trying 
that who ever made anything of himself worth 
making. You make your way by perseverance 
and patient waiting. And do not be discouraged 
because you do not become famous in a day, be- 
cause you have no clients the first day you put 
your shingle out, because you have poor success 
when you do get them. Stand by your guns. Be 
patient, be hopeful, be reliant. 

"Did you tackle the trouble that came your way 

With a resolute heart and cheerful ? 
Or hide your face from the light of day 

With a craven soul and fearful ? 
O, a" trouble's a ton, or a trouble's an ounce. 

Or trouble is what you make it, 
.\nd it isn't the fact that you're hurt that counts, 

But only how did you take it? 

"You are beaten to earth? Well, well, what's 
that? 

Come up with a smiling face ; 
It's nothing against you to fall down flat. 

But to lie there — that's disgrace. 
The harder you're thrown, why, the higher you 
bounce ; 

Be proud of your blackened eye ! 
It isn't the fact that you're licked that counts; 

It's how did you fight — and why ? 

"And though you be done to the death, what then ? 

If you battled the best you could, 
1 f you played your part in the world of men. 

Why, the Critic will call it good. 
Death comes with a crawl, or comes with a 
pounce. 

And whether he's slow or spry. 
It isn't the fact that you're dead that counts, 

But only how did you die?" 



66 



THE HOSPITAL BULLETIN 



So stick to it : don't give up. And always be- 
lieve in yourself and in your ability and in your 
future, and do not get married until you get some- 
thing for your wife to live on. It is hard enough 
for one man to starve, but it seems to me to be a 
great deal worse if there are two to starve. And 
if you love your wife as well as you ought, you 
wouldn't eat anything, so that she could have a 
full meal. So just wait a while. Do not wait too 
long, however. Do not wait until you get ten 
thousand dollars a year ; when you get a thousand 
dollars that is enough. Do not wait too long. 
Let your faith be always in the future. 

And then there is a service which you owe to 
the State. You ought to make a good living, you 
ought to prepare yourselves to do it, and to work 
hard to do it, but that is not the object of life; 
that is not the ambition which is carried in the 
phrase noblesse oblige. True, every man wants 
to make a living, and he must make a living, and 
does make a living, except in extraordinary cases. 
but the acquisition of wealth should never be the 
sole ambition of any educated man. Let the un- 
educated people get rich ; let the educated people 
ser\'e the State. In that service you must sacrifice 
to a large extent your own personal views and 
preferences. I do not believe there is a man 
living who ever really has a proper feeling of 
contentment and self-respect who cannot look 
back every day on some service he has done 
humanity. The mere selfish acquisition of wealth, 
it seems to me, is the most unsatisfying feeling 
that coukl come to a human being. But if you 
feel that you have done your client a service be- 
fore the bar, if }ou feel that the sick man's pains 
have been alleviated and he has been ]iut upon the 
road to recovery, if you feel that the man who 
leaves your dental chair has a better set of teeth 
than he ever had before, and if you feel that the 
prescription you put up at the corner drug store 
is of the purest and best drugs, you can feel that 
you have done a service to humanity in doing that. 
In other words, a service well done- — I do not 
care how menial it is — is a service to humanity. 
They say of the Roman Senators that in derision 
of Cato, and being angry with hitn, they created 
the office of Commissioner of Sewers, and to 
humiliate him they appointed him the commis- 
sioner of the great Cloaca Maxima, and he so 
discharged the duties of that despised office, with 



such benefit to the State, that ever after that to 
be Commissioner of Sewers was the highest 
honor to which a Roman Senator could aspire. 
So never despise a thing because it is menial, but 
do it well. I read the other day of a man who got 
a prize of one hundred dollars for plotighing the 
best furrow in a field out in Illinois. I would 
have been as proud to get that hundred-dollar 
prize as if I had won the gold medal at this Uni- 
versity. Those of you who are going to get 
those medals to-day know how proud }0u are. 
But I do not care how menial the service is if you 
do it^ well, especially a service to humanity, and 
unless it is done well you are not doing your duty 
to humanity. 

Service should be the cry, the ambition of every 
educated man. Service, service, service! To do 
something to help the world along. The world 
will recognize you not in proportion to your claims 
upon the world, but in proportion as you serve 
the world. The world has no sentiment. You 
are going into the great capacious maw of this 
great world, and you will be eaten up, swallowed 
whole, and the world will pay no attention what- 
ever to you until you make yourself felt upon the 
surface of the earth by your service, and not by 
your claims, nor by your diplomas nor your 
science, but by what you do. That is the meas- 
ure by which the world will gauge you and judge 
you in the future. Service ! Do something to 
help the world along. 

"There are hermit souls that live withdrawn 

In the place of their self-content ; 
There are souls like stars, that shine apart 

In a fellowless fimiament. 
There are pioneer souls that blaze their paths 

Where the highways never ran. 
But let me live by the side of the road, 

And be a friend to man ! 

"Let me live in a house by the side of the road. 

Where the race of men go by — 
The men that are good, and the men that are 
bad— 

As good and as bad as I. 
Why should I sit in a scorner's seat. 

Or hurl a cynic's ban ? 
Let me live in a house by the side of the road,. 

And he a friend to man ! 



THE HOSPITAL BULLETIN 



67 



"I see from my house by the side of the road, 

By the side of the highway of life, 
The men that press on with the ardor of hope, 

And the men that are faint with strife. 
But I turn not away from their smiles nor their 
tears — 

Both parts of an infinite plan ; 
Let me live in a house by the side of the road. 

And be a friend to man ! 

"I know there are brook-gladdened meadows 
ahead, 

And mountains of wearisome height, 
And the road passes on through the long after- 
noon, 

And stretches away to the night. 
But still I rejoice when the travelers rejoice, 

And weep with the strangers that moan. 
Nor live in my house by the side of the road, 

Like a man that dwells alone. 

"Let me live in a house by the side of the road. 

Where the race of men go by ; 
They are good, they are bad, they are weak, 
they are strong. 

Wise, foolish, and so am I. 
Then why should I sit in a scorner's seat. 

Or hurl a cynic's ban ? 
Let me live in a house by the side of the road. 

And be a friend to man !" 



URTICARIA."* 



By Norman T. Kirk, M.D., 

Assistant Resident Phxsician in University 

Hospital. 



Synon \uis. — Hives, nettlerash. 

Classified as angioneurosis. 

Definition. — Urticaria is an anaphylactic mani- 
festation produced in a sensitized subject by cer- 
tain specific toxic proteids or chemicals, character- 
ized by lesions of the skin or mucous membranes, 
evanescent, whitish, pinkish or reddish elevations 
or wheals, variable as to size and shape, attended 
by itching, stinging and burning sensations. 

Etiology. — The causes of the various urticarial 
diseases have been divided into three heads — 
predisposing, internal, external. 

Predisposing.- — Sex — JNIore frequent in female. 



•Read bpforo University of Maryland Medical Society, Feb- 
ruary 21, 1911. 



Age — early childhood and middle adult life. 
Family history frequently shows gouty, rheumatic, 
neuro-arthritic, asthmatic and neurotic taints. 
F'unctional and organic diseases, especially of the 
ovaries, uterus and nervous system are frequently 
seen. It is often associated with jaundice, gout, 
rheumatism, purpura, and occasionally co-exists 
v.ith albuminuria and glycosuria. 

Among the internal causes, the condition ap- 
pears after the ingestion of certain foods, espe- 
cially shellfish, as clams, oysters, lobster, shrimp'; 
also pork, sausage, almonds, cucumbers, straw- 
berries, tomatoes, mushrooms, and even at times 
after milk and butter. Drugs frequently produce 
the condition, as copaiba, cubeb, chloral, turpen- 
tine, salicylates, quinine, opium, the iodids and 
many of the coal-tar products. 

It is frequently seen after the use of antitoxins, 
vaccines and the Pasteur treatment for rabies. 

Emotional or psychic causes, such as anger, 
fright or sudden grief, seem to excite an outbreak. 

Among the external causes are irritants such as 
the sting of the nettle, jellyfish, wasp or caterpil- 
lars ; and occurs in oyster shuckers and has been 
known to occur in sensitized persons by applica- 
tion of egg-white to the skin. All of the above 
have been seen in clinical observation. Stelwagon 
says there are many causes, but a peculiar indi- 
vidual predisposition is necessary, inasmuch as 
the same cause may not produce the eruption in 
dififerent individuals. 

Along this line more recent work and thought 
has brought out the hypothesis, and some experi- 
mental work has been done to show that urticaria 
is an anaphylactic phenomenon, closely allied to 
asthma, and is caused by certain specific proteids; 
either animal of vegetable in origin, acting as a 
toxin to those subjects which have been sentitized 
to that particular proteid. An urticarial rash is 
frequently seen accompanying or is one of the 
symptoms of an anaphylaxis following a second 
injection of an antitoxin in the so-called serum 
poisoning. The condition occurred in a fellow- 
classmate after the course of treatment for rabies. 

Experimental work showed that serum, taken 
from a inan who for two years after eating a sau- 
sage suffered from an immediate eruption of net- 
tlerash whenever he ate pig meat, injected into 
a guinea pig excited immediately an extremely 
clear anaphylaxis with regard to pigs' serum. 

It would seem, then, that these phenomena of 
hypersusceptibilit}' to certain definite proteids 



68 



THE HOSPITAL BULLETIN 



nia\- be congenital, acquired or inherited; that 
these proteids may be absorbed from the food in 
the digestive tract through the circulation, olfac- 
tory tract or by injections, and is always a spe- 
cific condition. Persons sensitized to crab are not 
susceptible to berries, or vice versa. The causes 
mentioned above and grouped as internal and ex- 
ternal contain the specific proteids. 

Pathology. — The condition is an angioneurosis, 
the lesions which are found on the skin being 
primarih' at least due to vasomotor disturbances, 
brought about by the action of the toxic proteids. 
Barthilemy believes dermatographism to be due 
to a toxic vasomotor dermatoneurosis. 

The urticarial lesions are due to dilatation, fol- 
lowing spasm, of the arterioles, resulting in eflfu- 
sion with migration of leukocytes. This condi- 
tion causes pressure on the central portion, bring- 
ing about paleness, which was preceded by pink- 
ness and redness, the darker tint on the periphery 
and size and shape of the lesions being due to the 
blood, which has been pressed backward, and the 
depth of the involvement. 

There seems to be an increase in the secretion 
of lymph, as well as a paralysis of the vessel walls. 
In the ordinary forms only the superficial layers 
are involved, while in urticaria gigans the whole 
thickness is involved, and in the edematous variety 
infiltration occurs in the loose meshes of the sub- 
cutaneous areolar tissues. The pathological 
anatomy of a wheal shows it to be more or less of 
a firm elevation of a circumscribed or somewhat 
diflfuse collection of semifluid material, especially 
limited to the corium, which has been shown by 
Dr. T. C. Gilchrist to be the seat of an acute in- 
flammatory change. The blood vessels, especially 
around the sweat ducts, are enlarged, contain and 
are surrounded by a large number of polynuclear 
leukocytes, while the lymph spaces contain a gran- 
ular debris. Mast cells are found in the corium. 
The epidermis is not involved. 

Symptoms. — The urticarial eruptions are ery- 
thematous in character, usually come on suddenly, 
may be preceded by burning or itching and con.sist 
of scanty or profuse eruption of pea or bean- 
sized elevations, linear streaks or small or large 
irregular ])atches, or admixtures of these forms. 
The distril)ution may be localized or general. The 
outbreak may he preceded or accompanied by 
gastrointestinal symptoms, febrile action at times 



in acute, severe cases, or none of these may oc- 
cur. The lesions are fungacious in character, dis- 
appearing and reappearing in the most capricious 
manner. They are firm to the touch, and vary in 
color ; pinkish or reddish, with white central por- 
tions. 

The subjective symptoms are usually quite 
marked, consisting of stinging, intense burning 
or itching sensations. These may last from a few 
minutes to half a day, disappearing only to re- 
appear again. The intervening skin is normal. 
If the lesions persist for several days or a week, 
condition is known as urticaria persistens. 

Ill-defined pufifiness of the hands and feet oc- 
curs at times with above subjective symptoms. 

During the outbreak it is usually possible by 
drawing a pencil somewhat firmly over the sur- 
face to bring out linear wheels. This will re- 
main from a few minutes to several hours ; condi- 
tion is known as urticaria factitia or dermato- 
graphism. 

The eruption is not always confined to the ex- 
terna! surfaces, but the mucous membranes of the 
mouth, throat, larynx, or even intestines, may be 
involved. 

Numerous forms of lesions exist, as giant 
urticaria or acute circumscribed edema, which is 
a localized edema, occurring in the loose subcu- 
taneous tissues airound the mouth, eyelids, ears 
and scrotum, and may be free from subjective 
symptoms, coming on rapidly, lasting for a day 
or so, to disappear again. 

L^rticaria may be acute or chronic, usually the 
former, lasting from a few hours to several days. 
Periods between attacks vary, depending upon 
the e.xposure to the etiological factor. The 
chronic form — urticaria persistens — has the same 
features as acute, save the duration is longer, con- 
dition remaining for days and weeks with marked 
suffering in general health of the patient, due to 
worry, etc. .Several other forms exist. 

Diagnosis. — Is usually easy from the distribu- 
tion and subjective symptoms, their evanescent 
nature and dermatographism, which is usually 
present. 

Prognosis. — The acute disease is of short dura- 
tion, disappearing spontaneously or as a result of 
treatment in a few hours or several days. It has 
tendency to recur when person is exposed to the 
etiological cause. The prognosis of the chronic 



THE HOSPITAL BULLETIN 



69 



form is to be g'liarded until the causing toxin can 
be found. 

Treatment. — The prophylactic treatment con- 
sists in finding the specific toxin to which the pa- 
tient is sensitized. Remove this from his diet if it 
be found in his food and the attack will not recur. 

To relieve the condition we should aim to first 
get rid of the toxin by free purgation and elimi- 
nation, and put the patient on a light diet for a 
few days. Give antacid remedies internally, as 
sodium bicarb., salicylates, etc. Ichthyol in as- 
cending doses is recommended by some; quinine, 
atropin and coal-tar products often do good. 
For the local condition give sodium bicarb, bath, 
soothing ointments or wash, as carbolic ointment, 
calomine lotion, etc. 

The chronic form is the most obstinate. Pre- 
disposing factors, as internal or ovarian trouble, 
neurotic and gouty disturbances, diabetes and ne- 
phritis, should be sought for, treated or removed 
if possible. 



MORTON'S TOE. 



By T. Gay Whims, Senior Medical Student, and 
Nathan Winslow, M.D. 



The disease takes its name from Dr. Thomas 
G. Morton of Philadelphia, who first described 
it, and is characterized by acute cramping pains 
at the base of the third or fourth toes. It occurs 
in nervous persons, most frequently in women ; 
children are very rarely affected. Heredity may 
play some role in the causation of the disease. 

The exciting cause comes from the plantar 
nerves being pinched or pressed upon by the 
heads of the metatarsal bones, the normal relation 
between these having been for some cause dis- 
turbed. This disturbance in the relation of the 
metatarsal bones is usually brought about by 
wearing shoes which are too tight. The condi- 
tion is often associated with flat foot. 

The pain usually comes on suddenly while the 
patient is walking, and it may be so severe that 
she has to sit down at once and remove her shoes. 
The pain, which is sharp and cramping, is in this 
way partly relieved. Rubbing also helps to allevi- 
ate it. After the acute attack a sense of soreness 
and numbness remains. The pain can be pro- 
duced by squeezing the foot in the hand. The 



attacks tend to become more frequent and severe. 
Plantar flexion of the toes is usually and dorsal 
flexion sometimes limited. The pain is often ac- 
companied by a snapping of the metatarsal bones, 
and this has been known to be the chief symptom 
in this condition. The arch of the foot may be 
somewhat lowered, the front of the foot may be 
flattened with a depression on its dorsum, over 
the middle metatarsals, or it is possible for the 
foot to be normal in shape. The characteristic 
symptoms make the diagnosis easy. 

Mild cases in which there are no deformities 
of the foot may be cured by employing massage 
and by wearing of properly fitting shoes. In cases 
with deformity it is usually necessary to employ 
braces or plates of such a shape as to overcome 
the deformity. The gastrocneinius muscle is 
sometimes contracted, and should in such a case 
be stretched. In severe cases removal of the distal 
end of one of the metatarsals, and even resection 
of the metatarso-phalangeal articulation, have 
been resorted to. The cure from these operative 
measures may not be permanent, however. Some 
cases are reported to have been cured by excising 
a portion of the superficial branch of the external 
plantar nerve. 

Rel<ort of Case. — Miss E. S. W., aged 24, 
white, came under observation two years ago for 
severe pain in fourth metatarso-phalangeal articu- 
lation. The pain was cramp-like, extremely ex- 
cruciating in character and came on stiddenly 
while walking. It was only relieved by removal 
of shoe and rubbing. With time the pain grad- 
ually became worse and occurred at more frequent 
intervals. The joint was sore on pressure and 
was sore to the touch for some time after the at- 
tack. The dorsal surface of the foot was slightly 
swollen and red. 

A felt pad was placed under the joint to no 
avail, so operation was advised, which was con- 
sented to. 

On the 14th of May, 1910, the patient was 
anesthetized, the operative area properly cleansed, 
and a dorsal incision made directly over the joint 
and carried down to the bones to the side of the 
extensor tendons. The head of the fourth meta- 
tarsal and the proximal end of the fourth phalan- 
geal bone were excised, and a few strands of silk- 
worm gut were inserted as a drain. These were 
removed in two days and the wound allowed to 
close by primary intention. The patient was about 
in a week, and since then has had no return of the 



THE HOSPITAL BULLETIN' 



symptoms. It is yet too early to prognosticate 
the ultimate result, but after a year and five 
months of continuous use, with no recurrence 
of pain, we may reasonably assume she is per- 
manently cured. 



DIRECT INGUINAL HERNIA. 



By Jas. J. Edelen, 
Senior Medical Student. 



There are two forms of inguinal hernia, the 
oblique and the direct. The oblique inguinal 
hernia is of very frequent occurrence and occurs 
as both a congenital and an acquired malady. On 
the other hand, direct inguinal hernia is a com- 
paratively rare affection, though perhaps it occurs 
more frequently than is generally thought to be 
the case. It probably occurs in about to per cent, 
of all cases of inguinal hernia in the adult. It 
may possibly be a congenital affection, but, if so, 
this occurs so very infrequently that it mav be 
regarded as an acquired disease in practically all 
cases. Males are much more frequently the sub- 
jects of this condition than females. Whilst it 
has been observed in childhood in a few cases, 
it is so infrequent during that period of life that 
in upward of 2200 operations in ch.ildren at the 
New York Hospital for Ruptured and Crippled, 
reported by Dr. William B. Coley, there was none 
for direct inguinal hernia. 

.lnatoin\. — Direct inguinal hernia derives its 
name from the fact that it does not traverse the 
inguinal canal, Init protrudes directly through the 
abdominal wall at the external abdominal ring, 
and does not descend into the scrotum. The 
hernia e.scapes from the abdominal cavity at Hes- 
selbach's triangle, a s]:)ace bounded internally by 
the outer edge of the rectus muscle, externally by 
the dee]i epigastric artery, and below by Poupart's 
ligament. The intestine either pushes the con- 
joined tendon in front of it, or passes through 
a slit in this structure or slips to the outer side 
of the conjoined tendon. The e])igastric artery 
invarialily lies to the outer side of a direct inguinal 
hernia, and the relation of the artery to the neck 
of tlie hernical sac determines whether we have 
to deal with an (jhlique or direct inguinal rupture. 



If the sac is on the outer side of the deep epigas- 
tric vessels it must be an oblique form of hernia ; 
if it is on the inner side of these vessels it is a 
direct hernia. The coverings of direct rupture 
differ somewhat from those of the oblique, being 
skin and superficial fascia, intercolumnar 'fascia, 
conjoined tendon, transversalis fascia and peri- 
toneum. The cord is usually situated in front of 
the hernia or to its outer side, and not behind it 
as in the indirect variety. 

Syniptoius. — There are the usual signs of her- 
nia, but the lump develops rather slowly and does 
not descend into the scrotum. The swelling is 
rather globular in shape and is situated closer to 
the penis than the oblique variety. The finger 
can be pushed directly backwards into the ab- 
dominal cavity and does not traverse the inguinal 
canal. Too much reliance, however, cannot be 
placed in the physical characteristics of this hernia, 
as frequently one is mistaken in the diagnosis, or 
the diagnosis is onlv made after the incision of 
the tissues. .Sometimes the bladder also pro- 
trudes in connection with direct hernia, and one 
should always bear in mind the possibility of this 
complication, and in operating for the cure of 
this form of hernia any abnormal appearance of 
the sac or surrounding tissues should excite sus- 
picion and cause especial care not to injure this 
viscus. When the bladder is incised it must be 
sewed up and a drain placed in the lower end of 
the wound. A direct inguinal hernia is liable to 
become strangulated, but apparently this does not 
often occur. 

Treatment. — In some cases it may be proper to 
wear a truss, but this is usually very unsatisfac- 
tory. In most instances a radical operation should 
be performed. The best method is Bassini's, but 
the results are not so good as in the oblique va- 
riety. Coley gives 85 per cent, of cures in direct 
inguinal hernia. The occurrence tliis session of 
several cases of this form of hernia in the service 
of Professor Randolph Winslow has prompted 
the writing of this brief essay. In oblique inguinal 
hernia Professor Winslow usually employs Fer- 
guson's method ; that is, the spermatic cord is 
buried beneath the internal oblique muscle. In 
the direct inguinal hernia he performs Bassini's 
operation, and it is better to place the cord be- 
tween the skin and the aponeurosis of the external 
oblit|ue muscle, and to suture the external ab- 
dominal ring tit;htl\'. 



THE HOSPITAL BULLETIN 



71 



ADDRESS.* 



Bv Gi-:oR<;i-: R. Gaitiier. 



It is a difficult task in addressing the alumni of 
this old L'niversity of Maryland to suggest any 
new or interesting train of thought for your con- 
sideration. In the splendid training which the 
college graduates now enjoy, and in the present 
infinitely varied means for diffusing intelligence 
and ideas throughout the land, it is practically 
impossible for any speaker in an evening's ad- 
dress to portray the modern tendencies of the in ■ 
tellectual thought of the day or the varied achieve- 
ments of our complex civilization in the few min- 
utes which I shall trespass upon your attention. 
It is my purpose, if possible, to call }-our atten- 
tion not to these positive requirements, but to 
some of the factors in man's development which 
in mv mind are most important, and yet whicii 
are being largely neglected in the mad rush of 
modern development and the complex conditions 
of modern civilization. The old division of the 
powers of mankind into three great agencies 
seems as vital to me today as in every age of man's 
life upon this earth. The intellect, the will and 
the emotional or spiritual part of man are the 
forces through which his development and prog- 
ress have been created. In the wondrous de- 
velopment of all channels and institutions for in- 
vestigation, education and original research of 
the present age there is but little danger that the 
intellect of man will not receive all of the power, 
energy and training which has been so essential 
to the splendid development of the intellectual 
powers, and the "rule of reason" would seena 
destined to perpetual existence. Likewise, in the 
great domain of action the will of man finds ex- 
pression in the infinitely varied products of man's 
genius and eifort which surround us on every 
side and excite our wonder and admiration. The 
age which has produced such material results can 
never want for the stimulus which directs and 
moulds man's actions. The danger is rather that 
the creator will he lost in* the creation ; that the 
trium])hal car of invention and combination for 
the benefit of the great mass of humanity will 
operate like some human juggernaut in crushing 



•Dolivfred bpforo tlio Annu.1l Smoker of the Oradu.'jting 
Classes and the General Alumni Assoeiation of the University 
of Maryland. .Tune 1. 1911, at the Hall of the Medical and 
Chlrurgiral Kaculty of Maryland. 



out the inner life of the individual. The eternal 
lestless tide of modern civilization seems to 
sweep all forces before it in its resistless might. 

On the other hand, what has been the effect 
of these great agencies in the development of those 
qualities which make the charm of each individual 
life, and whose existence in the ages which have 
passed has brightened and glorified the pages of 
history? Is there any force in the universe com- 
parable to man's spirit, and to the many manifes- 
tations of its infinite power, which have broadened 
the horizon of humanity and lifted it beyond its 
carthh' environment? Is not the age of machin- 
ery and reason calculated to stifle rather than to 
develop these momentous forces which exist in 
each individual, and whose united strength has 
made the progress of the vi^orld ? Is there no place 
for the development of the finer qualities of man- 
kind in a civilization such as ours? Who of us 
has not thrilled at the enthusiasm and self-sacri- 
fice which swept over Europe at the time of the 
Crusades ? Who has not longed for the qualities 
which made the chivalry and romance of the 
I\Iiddle Ages ? Who has not gloried in the cease- 
less zeal, heroic endeavor and unselfish devotion 
of the army of martyrs and patriots of all the ages 
who have struggled and fought for the supremacy 
of human rights and the emancipation of suffer- 
ing races from tryanny and oppression ? Are not 
the qualities of patriotism, self-sacrifice, heroism, 
gentleness, courage and faithfulness as necessary 
for the welfare of mankind in this modern age as 
the material and intellectual development which 
we have acquired ? Nay, are they not more so if 
we are truly to enjoy the blessings of civilization? 
May the day speedily come in our national life 
when the qualities which make the man will be 
of more solicitude to our people than the protec- 
tion of our material possessions or the distribu- 
tion of our great productions. Already there are 
bright signs of a new era and a new epoch in our 
national life. In the future I trust and believe 
that we shall establish new standards of life and 
living : that health will be deemed of greater value 
than wealth ; that happiness will be paramount to 
mere physical comfort, and that mankind will 
once more realize that his world is a ''stepping- 
stone to higher things," and not a mere arena of 
senseless struggle or a stage setting for an empty 
play. And with the true development of the spirit 
of man, supplementing his matchless intellect, 
will come the revelation of the mysteries of an 



■J2 



THE HOSPITAL BULLETIN 



unseen world of spirit — one whicli surrounds us 
now on every side. 

"But while tliis muddy vesture of decay 
Dotii grossly close us in, we cannot see it." 



A REPORT OF THE PROGRESS OF THE 
NEW MATERNITY. 



By L. E. Neale, j\I.D., LL.D., Professor of Ob- 
stetrics ; E. H. Kloman, Ph.G., M.D.. Asso- 
ciate in Obstetrics; W. L. Byerly, M. D., 
L. H. Douglas, M.D., S. E. Lee, M.D., 
Resident Phvsicians. 



The old Maternity, situated at 622 West Lom- 
bard street, has long served the purpose as a free 
lying-in hospital, but until recently we have not 
been able to accommodate private obstetrical 
cases in the maternity department. On the first 
day of April, 1910, the new quarters were com- 
pleted in the general hospital, occupying the wing 
which had previously been the nurses' home and 
had been remodeled into a modern maternity. 
The chief fault with the old building was one of the 
marked features of improvement in the new one — 
!• c. the accommodations for private patients. 
The new Maternity has a private waiting ward, 
as well as a private puerperal ward. Each con- 
tains six to seven beds. These wards are modern 
in all respects and are situated in a part of the 
hospital where the patients are out of contact with 
those in the general hospital. Across the hall from 
the wards are the private rooms that are suited 
for those desiring better accommodations. These 
rooms are supplied with ideal furniture for the 
lying-in room. On the same floor is a private 
operating and delivery room, nursery, bath, diet 
kitchen and modern sterilizing-room. This whole 
floor is devoted to private patients. On the first 
floor above are two large wards for the free pa- 
tients, one for colored and one for white patients. 
These wards are also subdivided into waiting and 
puerperal wards. This floor has also its own op- 
erating and delivery room. The nursery is one 
of the great improvements. Instead of using the 
large beds to place infants upon, we now have 



separate beds. Each infant has its own separate j 

white enamel crib, and this makes isolation prac- ' 
tically a constant feature. The nursery also pos- 
sesses a modern incubator, where many of the 
premature infants are raised which otherwise 
would seem impossible but for this modern asset. 
The resident staff has recently been increased to 
three instead of two, and we have now one senior 
and two junior residents. A\'e also have a graduate 
nurse to superintend and train those nurses tak- \ 
ing their obstetrical training. As a result of all 
this modern equipment it gives us great pleasure 
to make a very favorable report after one year's 
trial. 

The number of cases treated for the year end- 
ing June, 191 1, has just doubled those treated the 
previous year, the greatest part of this increase 
being with the private patients. There were four 
times as many private cases this year as the year 
previous. This department now treats all abor- 
tions and miscarriages, which has heretofore been 
out of the question, due to lack of room and ac- 
commodations. 

The free out-patient department likewise in- 1 
creased, as you will see below. How has this in- | 
crease in the out-patient department helped our 
free clinic ? It has been our desire to have the 
abnormal and operative cases under our direct 
care. We aim to accomplish this by having our I 
residents go into the field and select such cases 
that require hospital treatment and bring them 
into the clinic before labor begins. 

This has given the student a better chance to 
see operative work, has given the residents better 
opportunity to do operative work, and has fitted 
the clinic with excellent material for post-gradu- 
ate work. The out-patient department has grown 
markedly. This is in part due to the care which 
the students are required to use in their work with 
free cases and frequent visits by the resident phy- ■ 
sicians. The students are required to make pre- \ 
liminary examinations, to keep in touch with and 
to report any abnormal case. j 

This gives them excellent training in palpation, 
and they are taught to make a diagnosis by exter- 
nal palpation, hence lessening the risks for in- 
fections. 

In the present graduating class each man will 
average 40 cases which he has seen and been as- 
sociated with, and of these he will average 15 
which he has personally attended in the out-pa- I 
tient department. 



i 



THE HOSPITAL BULLETIN 



73 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, June 15, 191 1. 



SOWING AND REAPING. 

"Behold, a sower went forth to sow ; and when 
he sowed, some seeds fell by the wayside, and 
some fell upon stony places, but others fell into 
good ground, and brought forth fruit." 

We have been sowing seed, good hard No. i 
wheat. The work has been somewhat interrupted 
by the examinations and other duties incident to 
the closing weeks of the session, but the seed has 
still been scattered. Doubtless much that has been 
sown has fallen by the wayside or upon stony 
hearts, but some has brought forth fruit. It is 
the unexpected that usually happens. This is true 
in almost all the avocations and contingencies of 
life. It has proven true in the short effort we have 
been making to excite interest and raise money 
for the endowment of the pathological department. 
Those best able to help us, and those whose loyalty 
should be strongest, have not responded to our 
cry as yet, while from far-off California, from the 
Red River of the North, from South Carolina, 
from the sturdy old North State, and from the 
mighty city on Manhattan, as well as from the 
progressive State of West Virginia, responses to 
our appeals have been received. We thank these 
friends, as well as those nearer at hand, who have 
encouraged us with their approval and helped us 
with their means. We shall continue our efforts, 
but we beg our alumni not to leave this matter 
entirely in the hands of a few of us, but let each 
one constitute himself a committee to push along 
the work. The writer would like to see an alumni 
chair of pathology, endowed by the alumni and to 
a large extent controlled by them. Let us con- 
tinue to sow the seed, for we believe "that in due 
season we shall reap, if we faint not." 



MAKE YOUR WILLS. 

Only two things are said to be certain in th.is 
world — death and taxation. If one has been for- 
tunate enough to acquire property, the taxgatherer 
will certainly find him out; hence it is not neces- 
sary to be too eager to hunt him up. He will come 
soon enough. Another unsought visitor frequently 
seeks us and takes all that we have. Next to lay- 
ing up treasure for our own eternal use, "where 
neither moth nor rust doth corrupt, and where 
thieves do not break through nor steal," is the duty 
of so disposing of our property that it may be de- 
voted to the best use possible. If one has a family, 
it is his duty and privilege to so arrange his affairs 
that those who are dependent on him shall be ade- 
quately provided for. He should, therefore, make 
his will, in order that his wishes may be carried 
out. Particularly is it important for the man of 
small means to make his will, leaving all his prop- 
erty to his wife, as in this manner the estate is kept 
intact and the wife is better able to provide for the 
family, if there are children. Another matter 
should also be kept in mind by the alumni of the 
University of Maryland, and that is the privilege 
of leaving a bequest, large or small, to the medical 
school for such purpose as may seem desirable to 
the donor. If our alumni would remember their 
alma mater in their wills they would rest with the 
assurance that some of their labor will not have 
been in vain. 



\\^\TCH THE FUND. 

The following contributions have been made 
to the endowment fund of the department of 
Pathology to June i : 

Robinson bequest $5,ooo 00 

Dr. Hugh Hampton Young, J. H. L^ . . . 100 00 

Dr. Gideon Timberlake 25 00 

Mr. H. P. Ohm 10 00 

Dr. Samuel W. Moore, D.D.S 25 00 

Dr. John J. R. Krozer, 1848 50 00 

Dr. Joseph T. Smith, 1872 10 00 

Dr. W. J. Young, 1872 25 00 

Dr. Thomas A. Ashby, 1873 100 00 

Dr. David W. Bulluck, 1873 100 00 

Dr. Robert Gerstell, 1873 5 00 

Dr. Randolph Winslow, 1873 100 00 

Dr. H. T. Harrison, 1874 5 00 

Dr. J. :\I. Hundley. 1882 250 00 

Dr. Henry Chandlee, 1882 10 00 

Dr. B. Merrill Hopkinson, 1885 25 00 



74 



THE HOSPITAL BULLETIN 



Dr. H. C. Reamer, 1885 

Dr. C. W. McElfresh, 1889 

Dr. Harry Adler. 1895 

Dr. Joseph L. Hirsh, 1895 

Dr. R. W. Sturgis, 1896 

Dr. Louis W. Armstrong, 1900 

Dr. Salvatore Demarco, 1900 

Dr. M. S. Pearre. 1900 

Dr. Nathan Winslow, 1901 

Dr. A. j\I. Shipley, 1902 

Dr. Hugh W. Brent, 1903 

Dr. Robert P. Bay, 1905 

Dr. S. L Meltzer, LL.D., New York 



10 


on 


100 


nn 


100 


00 


50 

7 


no 


nn 


ID 

50 

5 
50 

250 
25 

100 


DO 
GO 
00 


GO 

no 


no 


00 


10 


00 



$6,602 GO 



CHANGES IX THE MEDICAL FACULTY. 

At a recent meeting- of the Medical Faculty 
Dr. Harry Adler, Clinical Professor of Medicine 
and Director of the Clinical Laboratory, was 
elected Professor of Therapeutics and Clinical 
Medicine; Dr. Gordon Wilson, now Associate 
Professor of Practice of Medicine, was made 
Professor of Clinical Medicine, and Dr. Joseph 
Gichner was made Clinical Professor of Medi- 
cine and Associate Professor of Physical Thera- 
])eutics. We cannot commend these promotions 
too highly, and believe they will meet with the 
approval of ever\'one concerned in the welfare 
of the University. 

Dr. Adler is a B.A. of the Johns Hopkins 
L'niversity and an M.D. of the L^nivcrsity of 
Maryland, class of 1895. Since graduating he 
has been continuously associated with its teach- 
ing fofce. He is a tireless worker and a teacher 
of proven ability. 

Dr. Gordon AVilson is an i\I.D. of the LTniver- 
sity of Virginia and an ex-assistant resident 
physician of Johns Llopkins Hospital. He has 
been associated with the Department of Medicine 
of the University since 1903, and has given gen- 
eral satisfaction as a teacher alike to faculty and 
students. 

Dr. Joseph E. Gichner, class of 1890, has had 
added to the duties pertaining to the Chair of 
Clinical IMedicine those of Physical Therapeutics. 
The latter is a much-needed course, as physical 
remedies are gaining in importance daily. Dr. 
Gichncr's knowledge of the physical agents is 
such as to warrant the expectation of a very in- 
teresting as well as beneficial series of lectures. 



DISPENSARY REPORT. 

DISPENS.A.RY C.\SES, .\rEIL I, I9IO, TO APRIL I, I9II. 

Department. New. Old. Total. 

Surgical ( i ) 1,052 5,247 6,899 

Medical (2) 1,225 2,896 4,121 

Genitourinary (3)... 681 3.182 3.863 

Nervous (4) 269 1,658 1,927 

Stomach (4) 520 1,407 1,927 

Eye and Ear (5) 6S7 1,147 i,834 

Women (6) 68g 1,131 1,811 

Throat (8) 652 924 1,576 

Lung (7) 805 928 1,733 

Children (9) 583 733 1,316 

Skin (10) 351 523 874 

Orthopedic (11) 47 236 283 

Rectal ( 12) 36 44 80 

8,188 20,056 28,241 

Total new cases 8,188 

Old cases 20,056 



Grand total 28,244 

Grand total, 1909- 1910 25,881 

John Houff, M.D., 

Dispensary Physician. 



THE ONE HUNDRED AND FOURTH 

ANNUAL COMMENCEMENT. 

The annual commencement of the University 
of Maryland was held at the Lyric Thursday 
afternoon, June i, 191 1, at 4 o'clock. The order 
of exercises was as follows : 

Overture — "Fest" Leutner 

Selection — "Pink Lady" Caryl 

Waltz — "Spring Maid" Caryl 

Music — March, "Aida" Verdi 

Prayer by Rev. Oliver Huckel, D.D. 

Music — "Meditation from "Thais" Massenet 

Address to the Graduates, Harvey W. Wiley, Ph.D., 
LL.D., Chief of the Bureau of Chemistry, Depart- 
ment of Agriculture, Washington, D. C. 

Music — March, "Patriotic" Rosslyn 

Conferring of Degrees by Bernard Carter, LL.D., 

Provost of the University. 
Candidates for the Degrees "Bachelor of Arts" and 
Bachelor of Sciences" presented by the Dean of the 
Facuhy of .'Krts and Sciences. 
Candidates for the Degree "Doctor of Medicine" pre- 
sented by the Dean of the Faculty of Physic. 
Candidates for the Degree "Bachelor of Laws" presented 

1iy the Dean of the Faculty of Law. 
Candidates for the Degree "Doctor of Dental Surgery" 
presented ]iy the Dean of the Faculty of Dentistry. 



THE HOSPITAL BULLETIN 



/o 



Candidates for the. Degree "Doctor of Pharmacy" pre- 
sented by the Dean of the Faculty of Pharmacy. 

Conferring of Honorary Degrees. 

Presentation of a Bust of the late Prof. James H. 
Harris, M.D., D.D.S. 

Music — "Pas de Echarpes" Cliaminade 

Award of Prizes. 

Music — March, "Stars and Stripes" Sousa 

The address of Dr. Harvey W. Wiley appears 
on page 6i of this issue of The Bulletin. There 
were 203 graduates. They were presented by the 
deans of their respective departments, and were 
classified as follows : 

Bachelor of Arts 16 

Bachelor of Science 2 

Doctor of Medicine 70 

Bachelor of Laws 50 

Doctor of Dental Surgery 43 

Doctor of Pharmacy 22 

Students who received degrees are : 

B.\cHELOR OF Arts. 
Rowland K. Adams. 
L. Claude Bailey. 
Clark Ferguson Brown. 
E. Foster Davis. 
S. Carl Drake. 
Henry Lee Johnson. 
Wilbur L. Koontz. 
J. Eccleston Marsh. 
John L. Morris. 
Robert Graham Moss. 
Eugene M. Owen. 
Thomas Parran, Jr. 
Emerson B. Roberts. 
George E. Rullman. 
William Stanley. 
Herbert Douglas Taylor. 

B.VCHELOR OF SCIENCE. 

John Frederick Koenig. 
William Roland Vansant. 

Doctor of Medicine. 
Edward Garrett Altvater, Maryland. 
Burt Jacob Asper, Pennsylvania. 
Henry Benedict Athey, Maryland. 
Walter Compton Bacon, Maryland. 
Mordccai Lee Barefoot, North Carolina. 
Frederick Lewis Blair, Rhode Island. 
Buchlcr Shoup Boyer, Maryland. 
Archie Eugene Brown, South Carolina. 
Ernest S. Bullock, North Carolina. 
William Luther Bycrly, Maryland. 
Samuel Hopkins Cassidy, Tennessee. 
Belton Drafts Caughman, South Carolina. 
Henry Dickinson Causey, Delaware. 
Herbert Augustus Codington, Georgia. 
James Erwin Diehl, Pennsylvania. 
Richard C. Dodson, Maryland. 
Louis Harriman Douglass, Maryland. 



Charles L. Dries, Pennsylvania. 

William Joseph Durkin, New York. 

James Joseph Edelen, Maryland. 

Joseph Benjamin Edwards, South Carolina. 

Otto Fisher. Virginia. 

Jacob Jesse Greengrass, New Jersej'. 

Isidore Isaac Hirschman, Maryland. 

Abraham Lewis Hornstein, Maryland. 

Grover Latham Howard, Virginia. 

John Thomas Howell, North Carolina. 

Raymond Garrison Hussey, North Carolina. 

Jose E. Igartua de Jesus, Porto Rico. 

Kenneth B. Jones, Maryland. 

Charles Hutchison Keesor, West Virginia. 

Charles Edward Kernodle, North Carolina. 

Charles R. Law, Jr., Maryland. 

Samuel Engle Lee, Maryland. 

Frank Levinson, Maryland. 

Willis Linn, New York. 

Paul Pressly McCain, South Carolina. 

Lawrence E. McDaniel, South Carolina. 

Isaac Michel Macks, Maryland. 

Manuel Eulalio Mallen, Santo Domingo. 

William Clinton Marett, South Carolina. 

George Yellott Massenburg, Maryland. 

John Guirley Missildine, Pennsylvania. 

Allen T. Moulton, Massachusetts. 

Adolph Mulstein, New York. 

Walter Saulsbury Niblett, Delaware. 

Elijah Emera Nicliols, Delaware. 

Vernon Llewellyn Oler, Maryland. 

John Ostro, Delaware. 

James Earle Quigley. Pennsylvania. 

Themistocles Julian Ramirez, Porto Rico. 

Stanley H. Rynkiewicz, Pennsylvania. 

Harry Bagenstose Schaefifer, Pennsylvania. 

Charles Louis Schmidt, Maryland. 

Dallas C. Speas, North Carolina. 

Louis Stinson, Mississippi. 

Joseph Stomel, Pennsylvania. 

Eniniett O'Brien Taylor, South Carolina. 

Ralph Leland Taylor, Georgia. 

Joseph Enloe Thomas, South Carolina. 

Grafton Dent Townshend, Maryland. 

Ralph J. Vreeland, New Jersey. 

Louis Kyle Walker, North Carolina. 

Charles Stuart Wallace, Oklahoma. 

Sydney Wallenstein, New York. 

Charles Alexander Waters, Maryland. 

Albert G. Webster, Maryland. 

Thomas Gay Whims, West Virginia. 

Java Cleveland Wilkins, North Carolina. 

Richard Lloyd Williams, Pennsylvania. 

Prizem.\n. 

University prize, gold medal, Burt Jacob Asper. 

Certificates of Honor. 

Charles Louis Schmidt, Thomas Gay Whims, 

Joseph Benjamin Edwards, Isaac Michel Macks, 
Themistocles Julian Ramirez, Charles Hutchison Keesor. 
Jose E. Igartua. 



76 



THE HOSPITAL BULLETIN 



Bachelor of Laws. 



Chester Alan Arthur 

Albrecht, 
Joseph Anthony Ambrose, 
James Conner Lee Anderson, 
Oswald Athanase Beaulieu, 
Charles Brown Bosley, 
Charles Henry Buck, 
William Winfield Scott 

Causey, 
John Leslie Cornell, 
James McGrath Crockett, 
Arthur Wilson Dowell, 
George Eckhardt, 
Thomas Joseph Fraley, 
Harry Freedman, 
Lee Ey-ster Gilbert, 
John Stewart Glen, 
Moses Henry Goldstone, 
Cyril Hansell, 
Edwin Hanson Webster 

Harlan, 
Louis Joseph Jira, 
Walter Eugene Keene, 
Dave Benjamin Kirsner, 
Anthony Walter Kraus, 
Philip Edward Lamb, 
Stephen Wells Leitch, 



Jacob Levine, 
Edgar Henry McBride, 
Cyprian William McSherry, 
Titus Lyde Mason, Jr., 
Charles McCurdy Mathias, 
James S. Clarke Murphy, 
Clapham Murray, Jr., 
Joseph Nathanson, 
Elbert Ray Nuttle, 
George Brauer Oehm, 
Peter Peck, 
Saul Praeger, 
Hannibal Hamlin Reid, 
George Albert Rossing, 
Herbert Alger Schloss, 
Harry Lamar Smith, 
Warren Adams Stewart, 
Philip Louis Skyes, 
Arthur Le Mar Vickers, 
Raphael Walter, 
Daniel Lloyd Wilkinson, 
John Wirt Wilmer, 
Harvey Hill Wilson, 
Eli Gardner Ziegler, 
Marshall Frederick Lahm 

Zeigler, 
Henry Zoller, Jr. 



Doctor of Dental Surgery. 
Lloyd Mehring Basehoar, Pennsylvania. 
Lawrence Welling Bonnoitt, Virginia. 
Daniel Bratton, Maryland. 
Rhodes Burrows, Connecticut. 
Lucas Angel Cambo-Ruiz, Cuba. 
Thomas John Claggett, Maryland. 
William Francis Courtney, Connecticut. 
William Lee Davidson, South Carolina. 
John Gleason Donnelly, Jr., New Jersey. 
Solomon M. Feldstein, New York. 
Howard Morton Finch, Connecticut. 
Leo Freiburger, Austria. 
Henry Andrew Folsom, Vermont. 
Risden Bennett Gaddy, North Carolina. 
Samuel Hawthorne Gluckman, New Jersey. 
Howard Crosby Greene, Connecticut. 
Sherman Jenkins Hamilton, New York. 
Seaborn James Hargrove, Jr., Georgia. 
A. Douglas S. narrower, Virginia. 
Daniel Edward Healey, New York. 
William Stuart Hart Heermans, Jr., New York. 
Lowell Philip Henneberger, Pennsylvania. 
Benjamin Frederick Herman, Connecticut. 
Daniel Pinkney High, Jr., North Carolina. 
Adolph John Hoffmann, New Jersey. 
Samuel Boss Johnston, Virginia. 
M. Lafayette Justice, North Carolina. 
Alfredo E. Justiz-Maspons, Cuba. 
Gabriel K. Jureidini, Egypt. 
Carter Inskeep Long, West Virginia. 
Arthur Franklin Lynch, Rhode Island. 
Henry Martin, Connecticut. 
Anibal F. L. Montcro y Diaz, Cuba. 



Taylor Phifer Nisbet, South CaroUna. 
Alexander Horn Paterson, Pennsylvania. 
Samuel Roth, Maryland. 
Robah Harrison Shore, North Carolina. 
Robert Thomas Skelton, New York. 
Allen G. Thurman Twigg, Maryland. 
Randolph M. Urmson, Pennsylvania. 
David Clark White, Louisiana. 
Charles E. Wingo, Jr., Maryland. 
Olin Harold Youngs, Connecticut. 

Prizeman. 
University prize, gold medal, Alexander Horn Pateison. 

Honorable Mention. 
Henry Andrew Folsom. 

Doctor of Pharmacy. 

Filiberto Artigiani, Italy. 

Noel Sifly Avinger, South Carolina. 

Flora Blattstein, Roumania. 

Carvilla Brian Boyd, Pennsylvania. 

Leon Dettelbach, Maryland. 

Paul Francis Flynn, Connecticut. 

Frederic Garrison, New York. 

Aloyuise Hergenrother, Maryland. 

Otis Leroy Johnson, South Carolina. 

Lawrence Regis Laroque, Maryland. 

Harry Clarendon Lewis, Maryland. 

Nicholas Thomas Lombard, Italy. 

Clifford Otto Miller, Ohio. 

Carl Wilhelm Oertel, Maryland. 

R. Gorman Piielps, Maryland. 

Thomas Ellsworth Ragland, Jilaryland. 

James Edwin Stokes, South Carolina. 

Joseph Samuel Sandler, Maryland. 

Powell Parker Towers, Maryland. 

George Harry Waltz, Maryland. 

William John Wannamaker, South Carolina. 

John C. Woodland, Maryland. 

Prizeman. 

Gold medal for general excellence, Clifford Otto Miller. 

Certificates of Honor in Order of Merit. 

Filiberto Artigiani, 
Paul Francis Flynn. 

Special Prizes. 

Simon medal for superior work in chemistry, Clifford 
Otto Miller. 

Gold medal for superior work in pharmacy, Thomas 
Ellsworth Ragland. 

Alumni medal for superior work in vegetable his- 
tology, Clifford Otto Miller. 

Distinctions in the Junior Class. 

Gold medal for general excellence, Herman Dietel, Jr. 

Honorable Mention in Order of Merit. 

Sidney J. Brown, Lee Hodges, 

Henry F. Hein, T. Stanley Smith, 

Ethan O. Fricrson. 



THE HOSPITAL BULLETIN 



71 



ITEMS 

By special request we give our record of the 
class of 1897 as follows : 

G. W. Banks, Shepherdstown, \\''. Va. 

Harry Lewis Baptist, Ivy, Va. 

Bernard Barrow, Barrows' Store, Va. 

Henry Thomas Batts, died July 10, 1902. 

A. E. Bell, Mooresville, N. C. 

William Newbold Bispham, Major, U. S. A. 

Peter P. Causey, Suffolk, Va. 

Harry C. Chappelier, Ilughville, j\ld. 

Calvin E. Clay, Martinsburg, W. \'a. . 

Charles Franklin Cooper, Pitts, Ga. 

Walter VV. Dodson, Laurens, S. C. 

Isaac C. Dickson, 3053 West North avenue, 
Baltimore. 

Frederick Dobyns, tio North Eutaw street, 
Baltimore, Md. 

J. J. Durrett, Fairmont, W. Va. 

Osceola Dyer, Franklin, W. Va. 

Arey C. Everett, Pegues, N. C. 

William E. Fahrney, Timberville, A'a. 

Percy Roland Fisher, Denton, Md. 

Henry M. Fitziiugh, Jr., Westminster, Md. 

Charles R. Foutz, Westminster, Md. 

Page A. Gibbons, Morgantown, W. Va. 

Lucius N. Glenn, Gastonia, N. C. 

Samuel Butler Grimes, Roland Park, Md. 

Samuel N. Harrell, Tarboro, N. C. 

Lurty Noel Harris, Mill Creek, W. \'a. 

John Ellis Hart, Deep Creek, N. C. 

Arthur C. Hearn, 156 Milton avenue, Balti- 
more. 

Timothy O. Heatwole, 2003 North Charles 
street, I'altimore. 

William Isaac Hill, .\lbemarle, N. C. 

James Lee Hopkins, Havre de Grace, Md. 

John .S. Howkins, 16 East Liberty street. Sa- 
vannah, Ga. 

Peter John, Laurinburg, N. C. 

James E. Kerr, Lilesville, N. C. 

Jennings M. King, Buckhannon, W. Va. 

Samuel Peachy Latane, died May i, 1910. 

George W. Lautenbach, 625 Mosher street, Bal- 
timore. 

James D. Love, Jacksonville, Fla. 

Carville V. Mace, Rossville, Md. 

Cliarles D. Marchant, Harmony Milage, \'a. 

William R. McCain, Charlotte, N. C. 

R. H. McGinnis, Jacksonville, Fla. 



L. Wardlavv Miles, Princeton University (not 
practicing). 

J. C. Monmonier, Jr., Hillsdale, Md. 

F. Alan G. Murray, Mt. Savage, Md. 

T. McL. Northrop, St. Pauls, N. C. 

R. Walter Patterson, Clarksburg, W. Va. 

Oliver Parker Penning, 171 1 St. Paul street, 
Baltimore. 

Walter Stith Philips, Rapidan, \'a. 

Richard F. Richards, Hampstead, Md. 

Compton Reily, 2025 North Charles street, Bal- 
timore (orthopedic specialist). 

Robert Conrad Rind, 121 East Madison ave- 
nue, Springfield, Ohio, 

Oscar Leslie Rogers, Sandersville, Ga. 

Sidney G. Sarratt, Union, S. C. 

Reverdy Sasscer, Upper Marlboro, Md 

Rupert Leroy Savage, Rocky Mount, ;^,'. C. 

Thomas Littleton Savin, 1349 York road, Bal- 
timore. 

Henry Franklin Schamel, Brunswick, Md. 

Charles L. Scott, Asheville, N. C. 

Gilbert Tyson Smith, Jr., U. S. G. and C. Sur- 
vey, stationed in Alaska. 

Guy Steele, Cambridge, Md. 

Charles R. .Stevenson, De Lancey, Pa. 

William H. Clendenin Teal, died January 28, 
1910. 

J. Brown Wallace, 322 Hyde Park avenue, 
Tampa, Fla. 

Charles A. Wiest, Stover, Mo. 

F. Delaphaine Willis, Newport News, Va. 

We are unable to locate the following members 
of this class : William S. Huggins, Garrett John 
Landers, W. H. Lippitt, X'V'illiam Matthews, Ed- 
win R. Ramsey. John J. Sullivan and Julius Wein- 
berger. We will thank any of our readers for 
any information as to their present location or 
other knowledge concerning them. 



Dr. Albert H. Carroll, class of 1907, is at Woods 
Hole, Mass., and will spend the summer there, 
working in the physiological and biological lab- 
oratories. 



Dr. Norman T. Kirk, class of 1910, has been 
appointed surgeon to the Atlantic Coast Line 
Railroad, to be located in their hospital at Rocky 
Mount, N. C. 



The University of Maryland Training School 
for Nurses held its commencement exercises on 



THE HOSPITAL BULLETIN 



Thursday evening, May ii, 191 1, at Lehmann's 
Hall. Rev. A. B. Kinsolving of Old St. Paul's 
P. E. Church, opened with prayer. The diplomas 
were conferred by R. Dorsey Coale, Ph.D., dean 
of the JNIedical Faculty, and the address to the 
graduates was made by Dr. Arthur M. Shipley, 
class of 1902, Professor of Materia Medica and 
Surgical Pathology. The graduates were ^lary 
Louise Gephart, ^Maryland; Anne Schooley 
Grubb, Florida ; George Allen Hutton, Maryland ; 
Frances Woodbridge Sprecher, INIaryland ; Eliza- 
beth Cromwell Patterson, Pennsylvania; Barbara 
Ellen Stouffer, Maryland; Mary Gertrude Brady, 
^Maryland ; Nellie Elizabeth Curtiss, Maryland : 
Alarvel E. Scarff, Maryland; Elizabeth Evelyn 
Robinson, Maryland ; Stella L'dore Ricketts, 
Pennsylvania ; Naomi Helland, Maryland : Ivy 
Irene Kinney, West Virginia ; Alva Mae ^^'il- 
liams, Maryland; Ruth Elizabeth Berlin, Penn- 
sylvania; Mary Ellen Sullivan, Massachusetts, 
and Jennie Rockhold Garner, Maryland. 



Dr. John C. Hemmeter left June 12 for Woods 
Hole, Mass., where he has taken a cottage for 
the season. He will move into his new home on 
Charles-street boulevard December i. 



wrist. There was not another doctor in town at 
the time, but Drs. Gibson and Timmerman came 
from Batesburg and set the fracture. The patient 
is doing well. 

"No braver thing than Dr. Riser's action has 
ever been seen in Leesville. There were about 
10 children, all small, on the grass in the park, 
and the horse was running directly for them. Dr. 
Riser was in no danger where he was, but he saw 
that some of the children would be crushed unless 
he saved them, and he did his best, absolutely re- 
gardless of danger to himself. Needless to say, 
the people whose children were saved by liis 
action will not soon forget him." 



Dr. Edgar G. Ballenger, class of 1901, of At- 
lanta, Ga., has just had published a book entitled 
"Genito-L'rinary Diseases and Syphilis." We 
wish Dr. Ballenger much success, both with his 
magazine — the Journal-Record of Medicine — and 
with his book. 



Dr. Randolph Winslow, class of 1871, will leave 
on June 17 for the annual meeting of the Ameri- 
can Medical Association at Los Angeles, Cal. 



The State, a daily paper of Columbia, S. C, 
publishes the following special from Leesville, 
S. C, concerning Dr. Luther Allen Riser, class 
of 1908, in its issue of May 25, 191 1 : 

"Yesterday afternoon, about 6 o'clock, a horse 
belonging to two fruit-tree agents from Tennes- 
see ran away here. The horse started running 
on the eastern edge of the town, and came through 
Main street, hitched to a buggy. At H. F. Hen- 
drix's store the horse turned west, and made di- 
rectly for a crowd of children who were playing 
in the street, all unconscious of their danger. 
Dr. L. A. Riser was sitting in his buggy in front 
of the Hendrix Hotel, out of danger, but seeing 
the danger of the children, he jumped in front 
of the mad animal, in an attempt to turn it out 
of its course. He did this, but as the animal 
turned the buggy went over and knocked the 
young man down. He caught under the buggy 
and was dragged several yards. Finally the horse 
broke loose from the buggy, and Dr. Riser was 
able to get out, with one knee skinned, his head 
bruised and his left arm broken just above the 



Mrs. Ethel Palmer Clarke, University Hospital 
Training School for Nurses, class of 1906, has 
been appointed superintendent of nurses at the 
L^niversity Hospital, succeeding Miss Bell, re- 
signed. Mrs. Clarke is a native of Richmond, and 
has just resigned as superintendent of the De Soto 
Hospital, Jacksonville, Fla. 



Miss Nettie Flanagan, class of 1902, has re- 
signed as superintendent of St. Luke's Hospital, 
Spokane, Wash. 



Misses E. A. Strohm and P. V. P'leasants, class 
of 19 10, have taken charge of the De Soto Hos- 
pital, Jacksonville, Fla. 



Misses Vera Wright and AL \'. Saulsbury, class 
of 1909, have taken positions at tlie Presbyterian 
Hospital of New Orleans, La. 



THE HOSPITAL BULLETIN 



79 



Miss Mary C. Wiggin, class of 1910, and Miss 
Nellie F. Ferrel, class of 1905, have joined the 
nursing corps, \J. S. N. 



Dr. Walter Van Swearingen (otherwise Sevy), 
class of 1904, is located at 1703 25th street N. \V., 
Washington, D. C. 



In a recent letter to Professor Randolph Wins- 
low, Dr. William Osier, Regius Professor of 
Medicine, Oxford University, England, says : 
"I am so glad to see the old school is booming. 
After all, you fellows have done splendidly for it, 
and it is a great credit to your brains and pockets." 



MARRIAGES 

Dr. Kivy I. Pearlstine, class of 1906, of Charles- 
ton, S. C, was married on Monday, June 5, 19:1, 
to Miss Rita Henriette Pinkussohn, daughter of 
]\Ir. and Mrs. I. S. Pinkussohn, also of Charleston. 
S. C. The couple will be at home after June 20 at 
126 Calhoun street, Charleston. 



Miss Anne E. Chapman, University Training 
School for Nurses, class of 1906, was married on 
May 24, 191 1, at Mount Calvary Protestant Epis- 
copal Church, Baltimore, to Mr. Joseph E. Wright 
of Easton. The couple will reside in Easton. 



DEATHS 

Dr. Richard Sappington, class of 185 1, died at 
his home in Waverly, Baltimore, Md., May 14, 
191 1, aged 84 years. Dr. Sappington was born in 
Darlington, Harford county, Maryland. March 
14, 1827, the son of the late Dr. John Sappington 
and Lavinia Bagley Sappington. His grand- 
father, Dr. Richard Sappington, for whom he was 
named, was a surgeon in the Continental Army in 
the Revolution. Of himself he says in a sketch, 
which is a treasured relic in his family : 

"Until 1846 I attended school in Harford 
county at Darlington Academy. There I read 
Caesar, Virgil and Cicero and acquired some 
knowledge of Greek. These languages were of 
great assistance to me later in the study of medi- 
cine. In 1846 I decided to leave Harford county 
for Baltimore city. I wrote to a friend in the city, 
Thomas Piggott, who had formerly lived opposite 



our home in Darlington, and asked him to find me 
a situation, 'even if it should be in a drug store.' 
fn 1846 I came to Baltimore and at once began to 
learn the apothecary business. 

"In 1848, on St. \'alentine's day, I bought the 
stock and fixtures of a drug store on Pennsylvania 
avenue and moved the outfit to Gay and Asquith 
streets. While conducting the business I attended 
the Maryland University, where I was graduated 
in March, 185 1. 

"Soon after I was graduated in medicine I ap- 
plied for admission to the Medical and Chirurgi- 
cal Society of Maryland. This society would not 
accept me because I was a druggist. I understood 
that the Maryland College of Pharmacy would 
not admit me because I was a physician. Later 
the College of Pharmacy changed in that respect, 
and I joined it." 

For 35 years Dr. Sappington kept a drug store 
on Gay street, between High and Front streets, 
and 14 years ago moved the business to the south- 
west corner of Gay and Lexington streets. He 
had lived 42 years in the house in which he died. 

Dr. Sappington was an honorary member of 
Concordia Lodge of Masons and a member of 
Monumental Lodge of Odd Fellows. For 25 
years he had been a vestryman of St. John's 
Church. 

A widow, Mrs. Aralanta Robbins Smith Sap- 
pington ; three daughters, Mrs. James H. Giese, 
Mrs. William G. Hall and Miss Gertrude E. Sap- 
pington ; two sons. Dr. Purnell F. Sappington of 
Belair and Mr. Reginald P. Sappington ; ten 
grandchildren and four great-grandchildren sur- 
vive him. 



Dr. Joseph T. Pindell, class of 1865, a medical 
cadet in 1864, and then for two years surgeon in 
the Army, at one time a member of the Council 
and Mayor of Wellsville, Kans., died at his home 
in that city May 22. 191 1, from nephritis, aged 81. 



^Vhile temporarily deranged from overstudy 
Dr. George W. Hafele, class of 1908. committed 
suicide of shooting himself with a .32 calibre 
revolver May 3, 191 1. at the residence of his 
sister, Mrs. C. Catherine Burke, 1833 Pennsyl- 
vania avenue, Baltimore. Dr. Hafele was a na- 
tive of Philadelphia, and came to Baltimore about 
nine years ago, entering the College of Physicians 
and Surgeons, and then finishing his course at 
the University of Maryland. After a short period 



8o 



THE HOSPITAL, BULLETIN 



of practicing in Baltimore he accepted a position 
as resident physician in the Adarian Hospital, 
Punxsutawney, Pa., resigning sisc months ago to 
engage in the practice of his profession. 



Dr. Frederick- B. Baker, class of 1888, died at 
his home in East Norwalk, Tenn., April 14, 191 1, 
aged 79 years, of cerebral hemorrhage. 



Dr. Reuben A. Wall, class of 1904, died at his 
home in Catonsville, Md., May 4, 191 1, aged 34 
years. Dr. Wall was the son of Alexander M. 
and Ida M. Wall. Dr. Wall was generally be- 
loved, and his classmates and associates \\ill 
sorely miss his presence. He is survived by his 
wife. 



Dr. Norman F. Hill, class of 1881, of The 
Walbert, Baltimore, died at the Mercy Hospital, 
Baltimore, May 12, 191 1, after an operation for 
gall-stones. 

Following the operation his condition im- 
proved, and at the end of two weeks he was able 
to leave his bed and be wheeled about the halls. 
Later, however, he suffered a relapse, and sank 
rapidly. 

Dr. Hill was born at Thorpland, Prince 
George county, ^Maryland, in 1847. He was the 
youngest son of the late Charles and Anne Eliza- 
beth Snowden Hill. After graduating from 
Georgetown L^niversity in 1866 he came to this 
city and studied medicine at the University of 
Maryland INIedical School, receiving the degree 
of doctor of medicine in 1881. 

Dr. Hill was a member of one of the most 
prominent families of the State. He traced his 
descent from the Hills of Somersetshire, Eng- 
land, one of whom came to the province of Mary- 
land in 1662 in company with Charles Calvert, 
the third Lord Baltimore. 

He is .survived by his widow, Mrs. Carolyn 
Hill ; one daughter, Mrs. Lylden Brice of Chester- 
town, Kent county. Maryland : six sons — Messrs. 
Norman F. Hill, Jr.. and Carroll E. Hill of St. 
Louis; Ernest M. Hill of Buffalo; Richard S. 
Hill of Atlanta, Ga., and Joseph K. and Nevitt 
S. Hill of this city — and two brothers. Mr. Eu- 
gene Hill of Kansas City, !M"., and ^Major N. S. 
Hill of this citv. 



Dr. Robert Atkinson, class of 1854, died at his 
home in Baltimore May 22, 191 1, aged 79 years. 



Dr. Cameron Tiggott, class of i88j, died at his 
home in Sewanee, Tenn., .April 30, 191 1, aged 55 
years. Dr. Piggott was Professor of Chemistry 
at the Universitv of the South. 



LABORATORY REPORT OF THE UNI- 
VERSITY HOSPITAL. 

Month of May. 

Blood Examinations. 

Leucocyte counts 169 

Erythrocyte counts 13 

Differential leucocyte counts 8 

Hemoglobin determinations 84 

Smears for malarial parasites 5 

Blood cultures 8 

Wasserman tests 18 

Widal tests 26 

33 r 

Umic Examinations. 

Routine urinalysis (chemical and micro- 
scopic ) 380 

Total estimation for urea 5 

Total estimation for albumen 4 

Total estimation for sugar 2 

391 

Misccllancons. 

Gastric contents (chemical and micro- 
scopic) 13 

Feces (microscopic, etc.) 13 

Sputum examination 18 

Bacteriological cultures and smears 

( from operative cases) 7 

Vaginal and ureteral smears 10 

Examination of spinal fluid 2 

Examination of pleural exudate 2 

Sections of tissue for microscopical ex- 
amination 15 

Autopsies 2 

82 

Total 804 

Dr. J. L. HiR-SH, 
Dr. H. J. AL\LDEis, 
Dr. R. Diller, 
Dr. R. C. Dodson. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
FRICE $1.00 PER YEAR. 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., JULY IS, 1911. 



No. 5 



REPORT OF TWO CASES OF FATAL 
GASTRIC HEMORRHAGE.* 



By A. Aldridge Matthews^ M.D., 
Class of 1900. 



Before reporting these cases I would like to run 
over briefly some of the causes of hemorrhages 
from the stomach due other than to cancer and 
ulcer, and I cannot do better than to quote from 
Dr. I. Boas. 

Besides ulcer and carcinoma, portal vein stasis, 
gastric varicosities, trauma, scurvy, hemophilia, 
leukemia, Hodgkin's disease, acute yellow atrophy 
of the liver, ruptures of blood vessels, acute in- 
fectious fevers, such as typhoid ; yellow fever, 
cholera, plague, malaria (Hemmeter), acute and 
chronic gastritis (ulcerosa) and pyloric stenosis, 
miliary aneurisms, corrosion through caustic 
poisons, syphilitic and arteriosclerotic conditions, 
hysteria, cholelithiasis, etc. The hemorrhages of 
gastric carcinoma are usually easily differentiated 
from those of ulcer- The former are, as a rule, 
small in quantity ; they do not bring about bloody 
stools, or at least very rarely ; the blood is decom- 
posed and of a coffee or chocolate brown color. 
Cases of carcinomatous ulcers and carcinoma of 
the cardia, in which severe hemorrhages occur- 
ring toward the end may terminate fatally, are 
exceptions. In rare cases of hysteria and crises 
gastriques hematemesis has been reported. These 
instances are very rare, and the picture is essen- 
tially different. In such cases, however, organic 
or functional nervous diseases may be coincident 
with ulcer, as Debove rightly emphasizes. 

Hemorrhages resulting from stasis in cases of 
liver affections, especially cirrhosis, may easily 
be mistaken for hemorrhages from gastric or 



♦Read at Mospnw. Idaho, April 10, 1911. "North Idabo Dis. 
trlct Medical Society." 



duodenal ulcers. Leichtenstern pointed out that 
there is a form of cirrhosis of the liver which may 
give almost the precise picture of the course of 
an ulcer. Repeated, usually very copious, gastric 
hemorrhages, which return in intervals of weeks 
and months, take place. The patients are very 
anemic, not at all jaundiced, ascites and enlarge- 
ment of the spleen are absent, probably on account; 
of considerable hemorrhages, through which the 
portal circulation is relieved. Leichtenstern 
found a latent cirrhosis of the liver in several cases 
of this kind which terminated fatally within a few 
days from repeated gastric hemorrhages. 

We should always, therefore, think of the possi- 
bility of a developing cirrhosis of the liver in all 
cases of sudden gastric hemorrhages of persons 
who had been healthy up to this time, and the more 
so if symptoms of a gastric ulcer have not preceded 
or followed a hematemesis (Oppolzer). Gastric 
hemorrhage or melena occurs in cases of chole- 
lithiasis with or without icterus, and may suggest 
gastric ulcer, particularly as other subjective or 
objective symptoms may be entirely absent at this 
stage, or may be masked. 

Differential diagnosis may be often difficult in 
cases where hemorrhages occur suddenly, and 
previous history does not give any hints. De- 
crease of liver dullness and enlargement of spleen 
may be decisive, though their absence does not ex- 
clude cirrhosis of the liver, as just mentioned. 
WHiere previous history is known, we have on the 
one side to pay attention to the presence of epi- 
gastric painfulness, which is either missing en- 
tirely or, if present, is only slight, and on the other 
side, syphilis or abuse of alcohol- 

Besides the above-named sources, there are cer- 
tain parenchymatous hemorrhages, for which 
Harttung suggested the name of "plica-hemor- 
rhage," as they Usually originate in the folds of 
the gastric and intestinal mucosa. In these cases 



82 



THE HOSPITAL BULLETIN 



the gastric mucosa may be perfectly intact, witli 
the exception of small erosions, visible sometime.; 
only by the magnifying glass. Dieulafoy recently 
described these occasionally fatal ecchymoses, 
which affect only the most superficial strata of 
the gastric mucosa, as "exulceratio simplex, " 
and sees in them the first stage of the true Cruveil- 
hier's ulcer. 

Case No. I. — White ; male ; single ; age 27 ; a 
carpenter by trade. Physical examination nega- 
tive, except liver dullness decreased, spleen palp- 
able. His past and family histories were negative, 
with the exception of having had several hemor- 
rhages from the stomach within the last two or 
three years. None of these hemorrhages were 
very severe, except the present one. He gave no 
history of being a bleeder, nor did he give any 
history of any gastric disturbance whatsoever, 
except a little dyspepsia, and he had drunk con- 
siderably at intervals. I saw him a short while 
after a hemorrhage, and suggested to him an oper- 
ation, thinking at this time that he had a gastric 
ulcer, although the symptoms pointing to an ulcer 
were rather negative. I had never seen a hemor- 
rhage from the stomach other than from ulcer or 
cancer at this time, and my diagnosis was made 
more from the hemorrhage than from any other 
symptom. He submitted to an operation, and, 
after thoroughly examining his stomach, I elicited 
no induration or thickening anywhere that would 
suggest an ulcer. Not being satisfied, I examined 
the stomach as carefully as I possibly could the 
second time, thinking I might have overlooked 
something, but was not any more successful than 
before. I did a gastro-jejunostomy, for I still 
thought there must surely be an ulcer which I 
could not find- This patient made an uneventful 
recovery, so far as the operation went, up until 
the eighteenth day, at which time he was up and 
about, but on that day he had a violent hemor- 
rhage from his stomach, vomiting blood ; also pass- 
ing blood in his stools, and died within 12 hours 
from the time hemorrhage started from shock. 

On this case I had a post-mortem, and found 
a hemorrhagic condition of the mucous membrane 
of the whole cardiac end of the stomach, extend- 
ing well up into the esophagus. There was no 
evidence whatsoever of ulcer anywhere to be 
found. I appreciate now that my gastro-jejunos- 
tomy was of no avail, and could not possibly have 
done him any good. The other pathological con- 
dition that I found was a large spleen and a much 



contracted liver, the cut surface showing a gray- 
ish-white appearance surrounding greenish-yellow 
island-like areas. 

The liver substance being much firmer than 
normal and cut with considerable resistance, I 
should have made my diagnosis of cirrhosis of 
the liver when I operated, but this was five years 
ago, and time, with experience, is our best teacher. 
My mind was centered on the trouble being in the 
stomach, and I did not consider these other con- 
ditions as I should and would do today. 

Osier claims that the most extreme grade of 
atrophic cirrhosis may exist without symptoms; 
so long as the compensatory circulation is main- 
tained the patient may suffer little or no incon- 
venience. The remarkable efficiency of this col- 
lateral circulation is well seen in those rare in- 
stances of permanent obliteration of the portal 
vein. 

Case No. II. — L. E. A.; age 33: white; 
male ; married ; occupation laborer ; family 
history negative; physical history negative; 
rarely took a drink ; no history or evi- 
dence of syphilis; physical examination negative. 
Past history negative, with the exception that 
about 14 months ago he was referred to me with 
a great deal of pain radiating over the upper part 
of his right abdomen and vomiting. This pain 
had persisted three or four days before I saw him. 
He gave no gastric symptoms, and claimed never 
to have suffered with indigestion or any gastric 
disturbance, although he gave history of having 
had several gastric hemorrhages, the first one oc- 
curring about seven years ago. He thought he 
vomited possibly three or four ounces of blood, 
and from that time up to the present he has had 
four hemorrhages of considerable size, each time 
vomiting anywhere from an ounce to four ounces 
of blood, and having tarry-black stools. About 
two years ago he had quite a severe hemorrhage, 
which incapacitated him from work for a few 
days, but at no time did he have the least distress 
or discomfort before or after eating, or during his 
attacks or hemorrhages. He has had no hemor- 
rhages for the past year. Upon palpating his ab- 
domen (14 months ago) I could detect a large 
hard mass extending down from imder the costal 
border to the right, which gave him considerable 
pain upon pressure, and moved up and down in 
deep breathing, which I diagnosed as a distended 
gall-bladder. 

I opened the abdomen, making the usual in- 



THE HOSPITAL BULLETIN 



83 



cision, and found a very nuicli distended gall- 
bladder, iiaving a whitish appearance and quite 
tense, which I drained, but found no stones — only 
viscid mucus. Neither could I detect any obstruc- 
tion or trouble in his cystic duct, although there 
was no bile present in the gall-bladder at that time- 
I inserted a tube, which I left in for about eight 
days. There was very little drainage, and that 
whicii did come away was only slightly stained 
with bile. I was very much concerned as to 
whether there was some obstruction in the cystic 
cliict which I had overlooked, but upon removing 
the drainage tube the tract healed at once, and he 
had no further trouble and no return of his old 
condition. I saw him several times between the 
operation and his present illness ; at no time did 
he have any further trouble or discomfort with 
his gall-bladder, and did laboring worlc from that 
time until present illness. 1 examined the stomach 
for ulcers, especially on account of his history of 
previous gastric hemorrhages, but apparently the 
stomach was normal at this time. 

He was again referred to me on December 19. 
1910, after having had several hemorrhages, and 
at the time I saw him he was practically bloodless, 
facial expression very much pinched, and the 
ordinary symptoms that go along with severe 
hemorrhage. I had him transferred to the hospi- 
tal, and transfused him as soon as I could get a 
suitable subject who would volunteer to give up 
his blood. At this time I opened a vein in his arm 
and used the radial artery of the donor, who was 
a young laborer (white). Would have preferred 
some blood relation for this, but he had none in 
this section of the country. The transfusion was 
a great success, the patient's condition improved 
immediately and his general appearance and con- 
dition was wonderfully changed for the better 
and his outlook bright, but the following night 
he had another hemorrhage, in which he vomited 
at least six or eight ounces of bright red blood, 
and his condition was the same as it was the day 
before. On this occasion I transfused him again, 
this time getting a brother-workman, using his 
radial artery and the vein in the opposite arm 
of the recipient, and the improvement was equally 
as much as it was the day before, but the follow- 
ing night he had another hemorrhage, and almost 
died from shock before relief could be had. And 
then again, the third donor, a large plethoric 
man, lawyer by profession, was used, and this time 
I used the radial of the donor and a superficial 



vein of the leg of the recipient. At this time his 
improvement was greater than at either of the 
preceding ones. The pinched expression left his 
face entirely, his ears became pink and, as I said 
before, I considered his condition better than it 
had been following the other transfusions. About 
15 hours later he had another hemorrhage, and 
died as a consequence. 

I might say, also, that I fed him gelatine the 
whole time that he was under my observation. 
Two of the donors were paid, or, in other words, 
hired to give up their blood. 

Of course, the question arose as to where he 
was bleeding from, whether from an ulcer or ero- 
sion, or just a hemorrhagic condition of the 
stomach due to cirrhosis of the liver. The condi- 
tion that was most forward in my mind was that 
of ulcer, although it made me feel doubtful, be- 
cause at no time had he ever complained of dis- 
tress or indigestion, and I could not elicit any such 
history from him, although I inquired into this 
especially. That made me a little skeptical, but 
upon a post-mortem I found nothing except a 
hemorrhagic condition of the mucous membrane 
at the cardiac end of the stomach. The rest of 
the mucous membrane and his stomach appeared 
to be normal. There was one place at least two 
inches in diameter that showed evidences of hav- 
ing bled near the esophegal opening. The gall- 
bladder was functionating, although very much 
thickened, and there was no evidence that it had 
given him any further trouble. There was no 
stones in any of his ducts. I had sections made 
of his liver, and found little or no cirrhotic con- 
dition existing, but there was a passive congestion. 
The size of the liver seemed about normal, but 
I had no means of weighing it at that time. 



In the April issue of The Bulletin we stated 
that we were unable to locate several members of 
the class of 1885. We have since learned that Dr. 
J. B. Carr died November 20, 1907; Dr. William 
P. Kennedy died November 9, 1902, and Dr. W. 
T. Spruill died July 28, 1895. We would be very 
glad if our readers would assist us in locating 
Drs. J. M. Emmitt, B. B. Halsey, E. K. Hardin, 
C. H. Janney, H. C. Jamison, D. T. E. Casteel, P. 

B. Carter, S. B. Dew, A. F. Keen, E. T. May and 

C. E. Rogers, all of the class of 1885. 



Dr. Harry W. Stoner, class of 1907, is recover- 
ing from an infected hand. 



84 



THE HOSPITAL BULLETIN 



SKIN-GRAFTING— WITH A REPORT OF 
TWO VERY SUCCESSFUL CASES RE- 
CENTLY PERFORMED IN THE UNI- 
VERSITY HOSPITAL BY DR. RAN- 
DOLPH WINSLOW, PROFESSOR OF 
SURGERY, UNR'ERSITY OF MARY- 
LAND. 



By Burt J. Asper, 'ii, 
Senior Medical Student. 



Skin-grafting is a part of that special branch 
of operative surgery to which the term plastic 
or reparative has been applied, and which has 
for its object the reconstruction of the contour 
of the body for cosmetic reasons, the readjust- 
ment of anomalous relations of parts for utilita- 
rian purposes, as well as the substitution of one 
organ or tissue for another to give physiological 
efficiency. 

The inception of this branch of surgery prob- 
ably dates back many centuries ; certain it is that 
in India the surgical restoration of the external 
nose, which is often cut off in that country for 
supposed marital infidelity, has been practiced for 
many years before the first published records of 
methods and results were put into the hands of 
the surgical profession. 

This was first done in the latter part of the six- 
teenth century, when Togliacozzi of Bologna pub- 
lished an illustrated volume in which he dicussed 
the possibilities of plastic surgery with reference 
especially to nasal reconstructions, but for nearly 
two centuries this important surgical contribution 
'made but little impression upon the surgical 
world. It was in the middle of the eighteenth 
century that the revival of plastic surgery was 
begun — when Rosenstein and Dubois discussed 
the possibility of replacing lost structures by re- 
parative operations and proved that reconstructive 
surgery was possible by securing historic evidence 
of noses and lips having been made from the 
tissues of forehead, thigh and buttock by Indian 
and Italian surgeons of previous centuries. Fol- 
lowing this the experimental work of John Hun- 
ter on the grafting of tissues was done. 

From this time on the interest in reparative 
surgery became very great, but the greatest strides 
were not taken tmtil after the investigations of 
Lister, which made the aseptic healing of wounds 
possible. From this time on the field of reparative 
surgery widened rapidly, and there were estab- 



lished as legitimate operative procedures success- 
ively, epidermis grafting, tendon transplantation, 
nerve grafting, arteriorrhaphy and arterial trans- 
plantation, oseoplastic resection and reconstruc- 
tion, thyroid grafting, etc., until at present the 
transplantation of internal organs, blocks of va- 
ried tissues and even of whole limbs seems a 
possibility of human surgery. 

The specific purpose of skin-grafting is to sup- 
ply a cutaneous covering to any part of the ex- 
ternal surface of the body, the superficial struc- 
ture of which has been lost from any cause what- 
ever; wounds, burns or ulceration, thereby either 
accelerating a healing which would have occurred 
very much more slowly, or rendering possible the 
production of continuity in tissue which nature 
unaided would never have effected, and at the 
same time avoiding the deformities and impair- 
ment of function which so constantly result when 
such raw surfaces are permitted to heal by the 
natural process of cicatrization. 

The physiological basis for the operation of 
skin-grafting is the process of growth and repair 
of living tissues, supplemented by the ability of 
groups of animal cells to retain their vitality for 
a short time, even when separated from all direct 
connection with the heart and central nervous 
system. 

Successful operations demand aseptic wounds, 
sound tissues and good general health of the 
patient. .-\s syphilis and lupus are frequently the 
catise of the lesions demanding skin-grafting, it 
is absolutely essential in the first disease that 
some months shall have elapsed since any mani- 
festations of syphilis were detectable, and that 
the patient shall have been treated for a prolonged 
period with antisyphilitic remedies, while in a 
patient who has suffered from lupus, it is impera- 
tive that all the diseased tissue should have for 
some time been destroyed. It is absolutely essen- 
tial to success that complete asepsis be secured 
and maintained, because all antiseptics endanger 
the vitality of the graft, and when in any part of 
the operation antiseptics are required to secure 
asepsis, they should be thoroughly removed by 
the prolonged use of sterile normal salt solution. 
The deprivation of the protoplasm of the cells of 
their living power by bacterial and chemical irri- 
tants constitute the chief cause of faihire in this 
operative procedure. 

Skin-grafting is performed in three ways — the 
Reverdin method, the Thiersch method and the 



THE HOSPITAL BULLETIN 



8S 



Wolfe or Krause method. In the first, very small 
particles of the epidermis with the underlying 
upper layer of the cerium are transplanted. In 
the second, long strips of the same material are 
used, while in the third, pieces of the entire thick- 
ness of the skin several square inches in size are 
transplanted upon the raw bed. The first two 
might with propriety be called epidermatoplasty ; 
the last dermatoplasty. The grafts are usually 
obtained from some other portion of the patient's 
own body, the skin of the front and inner side of 
the thigh and arm being preferable, since it is 
elastic and not apt to be excessively hairy, while 
the resulting cicatrization is on a part of the body 
covered by clothing ; or, the graft may be obtained 
from the body of another individual. It is best 
that the donor be young, and all possibility of 
specific trouble must be excluded, as syphilis may 
prevent the graft from taking. The skin of any 
of the lower animals may be employed, especially 
that covering the abdomen of the frog. Since it is 
not definitely known whether graft from the skin 
of a negro transferred to a white patient will re- 
main pigmented, it is best always to graft blacks 
from blacks and whites from whites. 

Thiersch's Method. — Thiersch states that heal- 
ing of a granulating surface results, first, from a 
conversion of the soft vascular granulation papillre 
by contraction of the young connective tissue cells 
into "dry cicatricial papillae" actually approximat- 
ing the surrounding tissues, thus diminishing the 
area to be covered by epidermis, and secondly, by 
the covering of these papillae by epidermic cells. 
Contraction having gone on as far as the laxity 
of the tissues will admit, and the capacity for de- 
veloping new epidermic cells by the margins of 
the wound being limited, the granulations of the 
imliniited central portion remain stationary, i. c.. 
vascular and soft ; few, if any, of these component 
cells having undergone development into con- 
nective tissue, the maximum of contraction has 
not yet been attained, but will be promptly reached 
if they are covered by epidermis. Furthermore, 
microscopically, two layers of granulation tissue 
are discoverable, the more superficial possessing 
vertically disposed capillaries, the deeper con- 
taining a horizontal network of vessels from 
which the former spring, coursing through a 
structure more or less dense, according to the age. 
A free removal of this upper soft layer of granu- 
lations, yet capable of full contraction, must be 
effected to prevent cicatricial contraction and the 



risk of separation of the epidermis, this danger 
being avoided by laying the graft directly upon 
the layer of granulations with horizontally dis- 
posed capillaries, to which layer the transplanted 
portions will become firmly adherent, and will 
remain so, undisturbed by cicatricial contraction. 

Method of Operating. — Complete asepsis hav- 
ing been secured as before indicated, and all anti- 
septics washed away with salt solution, the soft 
granulations are scraped away with a sharp spoon, 
including a small portion of the newly-healed 
margins if they do not appear healthy, and the 
bleeding surface irrigated. All bleeding is 
stopped by compression with an antiseptic pad of 
gauze. The operator then reverts to that portion 
of the body from which the grafts are to be ob- 
tained, usually that of the thigh or arm, the part 
having been previously shaved, sterilized and 
bathed with sterile salt solution. The skin is put 
upon the stretch by one hand, while with the other 
a wide, sharp razor is applied flatwise, best pre- 
viously wet with sterile salt solution, and the upper 
layerof the skin removed byato-and-fro movement 
of the knife, the skin also being wet with the salt 
solution. Each graft should be as broad and as 
long as possible, should include only the most 
superficial portion of the true skin with the corre- 
sponding epidermis, and should be immediately 
laid upon the prepared surface, upon which it is 
floated from the knife by salt solution. A probe 
may be used to facilitate this movement, draw- 
ing the edge of the graft on to the edge of the 
wound surface while slipping the blade away; 
subsequent correction of position may also be 
effected by the probe. Each graft must be gently 
pressed into place, and must be in contact with its 
neighbor, or, better, slightly overlapping its fel- 
low and the margins of the wound ; otherwise, 
separation of the grafts is apt to occur. 

Having placed as many grafts as desired, the 
grafted area is covered by rubber tissue, pre- 
viously perforated in many places, so as to allow 
the free escape of any fluid, serous or purulent, 
which may accumulate ; over this a dry gauze 
dressing so firmly applied as to press the graft 
against the raw surface. It is left undisturbed, 
usually, for five or six days. Some operators 
prefer an aseptic moist dressing, kept continu- 
ally wet. It is usually advisable to anesthetize the 
patient from whom the grafts are taken, although 
local infiltration anesthesia has been employed. 

The appearance of blood beneath the graft as 



86 



THE HOSPITAL BULLETIN 



indicated by a bluish color, while endangering 
their vitality, does not necessarily cause their loss. 
A pink tint at the end of several days usually in- 
dicates success, while if the grafts be at this time 
of a dead white color, they will probably exfoliate, 
although only the outer layers may disappear, 
while the deeper active ones remain ; sometimes 
the grafts are perforated by the granulations, and 
disappear for a time, to reappear as epidermic 
islets later on. The surfaces from which the 
grafts were obtained are dressed with dry sterile 
gauze, or first dusted with iodoform and then 
sterile dressings applied. 

The Thiersch method is very valuable ; by its 
use very large ulcers and wounds can be made to 
heal quickly. It is especially valuable in causing 
rapid cicatrization of large ulcers following burns, 
the grafts in such cases being applied as soon as 
the sloughs have separated and the surface can 
be made sterile, since delay allows cicatricial con- 
traction to become increasingly great. The im- 
mediate union between grafts and vivified granu- 
lation surface tends to obviate much of the dis- 
figurement likely to occur from vicious cicatricial 
contraction. This method does not make a deep 
wound where the grafts are cut, so that quite 
large surfaces will heal rapidly. Keetly states 
that a valuable use of this method is to line deep 
aseptic bone cavities, which frequently begin to 
fill up by tissue developing under the grafts. He 
also believes that epitheliomatous and tuberculous 
ulcerations which have been excised show less 
tendency than usual to recurrence if Thiersch's 
grafts are employed to fill up the gap in the soft 
tissues. 

Reverdin Method. — Having rendered the ulcer 
and the neighboring skin and the part from which 
the grafts are to be taken sterile, the point of an 
ordinary aseptic sewing needle should be thrust 
under the epidermis, the skin elevated and the 
grafts shaved ot¥ by a sharp scalpel, or cut with 
a pair of small curved scissors. To be sure of 
obtaining the deeper active epithelial layer, a small 
portion of the derm should always be removed. 
The grafts must then be gently deposited, with 
the cut downward, upon the granulations by 
means of the needle, avoiding pressure such as 
will induce bleeding. Perforated rubber tissue is 
then placed over the graft, sterile dressing applied 
and left undisturbed for four or five days. In 
many instances these small grafts shed their 
cuticle and become invisible, the operation ap- 



parently having failed from a loss of the entire 
graft ; but at the next dressing commencing 
growths of epidermis will often be shown by 
bluish-white spots not only where the grafts were 
supposed to have taken, but also where they were 
thought to have been shed. As the grafts extend 
eccentrically, each capable only of producing an 
area of about one-half inch of cicatri.x, they should 
be placed about half an inch from each other and 
the margin of the wound. The islands grow in 
extent, and apparently stimulate the edges of the 
wound or ulcer to similar activity, until after a 
time the islands of cutification coalesce and join 
with the margin, and the former raw surface be- 
comes completely covered with skin. As is also 
true in the case of the Thiersch method, if one 
grafting will not suffice, the operation should be 
repeated. 

Unfortunately, but little diminution of the cica- 
tricial contraction is effected by the Reverdin 
method, and, while healing is more rapidly se- 
cured, too often an almost equally rapid breaking 
down occurs of the new-formed cicatri.x, either 
from no recognizable cause or from causes which 
would be inadequate to produce such a result in 
a scar formed by the ordinary process of healing. 

Wolfe or Kraxise grafts consist of the entire 
thickness of the skin, and must be free from sub- 
cutaneous fatty tissue. The circumference of the 
free flap to be cut is marked by an incision through 
the skin. An end is then seized with forceps and 
raised, so that the operator is able to dissect it 
free from the superficial fascia. The knife used 
should be sharpened ; its edge should be turned to- 
ward the skin, in order to avoid raising some of 
the subcutaneous fatty tissue with the skin. The 
raw surface should not be touched with the finger, 
and the operation should be dry. The graft may 
be obtained by dissecting up skin and subcuta- 
neous fat from the deep fascia and then clipping 
all the fat away from the under surface with scis- 
sors. This method leaves a wound easily clo.sed 
after undercutting its margins. The graft is 
carefully laid in the bed that has been aseptically 
prepared, and is pressed into place, so as to drive 
out any air beneath it. Sutures may or may not 
be used. Dry dressings are to be firmly applied, 
and are not removed for about four days. Then 
there may be blebs on the surface, and it may look 
as if necrosis of the flap was about to occur. The 
blebs should be punctured and drained, and dry 
antiseptic dressings applied. They usually live 



THE HOSPITAL BULLETIN 



87 



if proper technique lias ]5een carried out, even if 
they are several square inches in area. Motion 
of the part to which the grafts are applied should 
be prevented by means of splints whenever neces- 
sary. 

C.\.SE I. SKIN-GRAFTING OF H.\ND, BOTH PALMAR 

AND DORSAL ASPECTS, AS FAR AS THE WRIST 

JOINT, FOLLOWING CRUSHING OF THE 

FINGERS AND DENUDATION OF THE 

HAND BY CORN-HUSKING 

MACHINE. 

Patient, E. R. ; white; male; age 16. Admitted 
to LTniversity Hospital to the service of Prof. 
Winslovv on the evening of January 4, 191 1. 

History. — On the afternoon of the above-men- 
tioned day, while feeding a corn-husking machine, 
patient introduced his right hand into the machin- 
ery to free an ear of corn which had become 
lodged ; in so doing the hand became caught, and 
dragged between the rollers. Patient threw ma- 
chine out of gear at once, but could not free his 
hand until machinery was taken apart by his fel- 
low-workers, the whole process requiring about 
15 minutes. The physician who was called 
dressed the wound and hurried the boy to the Uni- 
versity Hospital. Examination revealed that all 
four fingers and thumb of right hand were badly 
lacerated, and the skin of the remainder of the 
hand was entirely stripped off as far back as the 
wrist, very much after the fashion of the removal 
of a kid glove. 

Treatment. — Patient was prepared for opera- 
tion at once upon admission ; was given an anes- 
thetic and the hand thoroughly scrubbed up and 
treated with antiseptics, following which the skin 
was replaced over the denuded surface and su- 
tured in position, openings being made at several 
places through this skin for the insertion of drain- 
age. 

Temperature on admission was 99 5-10° F. 
The next day temperature reached 103 and pulse 
120, in the meantime patient suffering very severe 
pain. He was treated by ice to the head and 
anodynes, and 1500 c. c. of antitenanic serum was 
administered. The infection proved too virulent, 
and, despite the fact that the hand was kept im- 
mersed in a continuous hot bichloride bath, the 
replaced skin, and also the fingers, began to 
slough, the process continuing until the thumb 



and all the fingers were separated at the meta- 
carpophalangeal articulation. 

With careful attention the infection was over- 
come, and the general condition of the patient be- 
came very good, and the operation of skin-graft- 
ing was deemed advisable in order to shorten con- 
valescence, and also to prevent the deformity and 
loss of function, which would have resulted from 
cicatricial contraction had the raw surfaces been 
permitted to heal by the process of granulation. 

Operation.- — The grafting was done in two 
operations, the Thiersch method being employed 
in each. At the time of the first operation, on 
February 11, the dorsal surface was covered, the 
skin being taken from the left thigh. On March 
8 the palmar surface was grafted, the grafts this 
time being secured from the right thigh. At the 
time of this second operation there was present in 
the middle of. the area an island of cicatricial tis- 
sue about the size of a quarter. This was per- 
mitted to remain and the grafts made to sur- 
round it. 

Results. — The grafts took beautifully ; there 
was no sign of sloughing. The stump, which at 
the time of grafting was large and ruddy, and had 
scarcely any semblance to a hand, decreased in 
size progressively, until at the time of discharge 
it had assumed practically normal proportions. 
Patient was discharged on April 8, the hand being" 
completely covered by skin, with the exception 
of two small spots, dime-sized, one upon the 
radial and the other upon the ulnar side of the 
dorsal aspect of the hand, which were quite 
healthy in appearance. There was no cicatricial 
contraction whatever, motion at the wrist and be- 
tween the carpometacarpal articulations, including 
that of the thumb, being perfect. 

CASE 11. ANNULAR ULCER OF RIGHT LEG, LARGE 
ULCER OF LEFT LEG. 

Patient, Mrs. M. W. ; white ; age, 43 ; occupa- 
tion, housewife. Admitted to University Hos- 
pital on February 9 to the service of Prof. Ran- 
dolph Winslovv. 

History and E.vantination.— The duration of the 
ulceration on the left leg was given as four years, 
while that of the right leg was of six months' 
duration. No history of syphilis could be ob- 
tained. The left leg was encircled at a point 
about two inches above the internal maleolus by 
an infected sloughing ulceration about four inches 



88 



THE HOSPITAL BULLETIN 



in width. On the right leg, also about two inches 
above the internal maleolus on the internal aspect 
of the leg, was a second ulcer, which measured 
about as follows : Two and one-half inches in 
length, two inches in breadth at base and one inch 
at apex. Its surface was also sloughing and in- 
fected. Both legs were greatly thickened and in- 
durated, both above and below the ulcerated 
areas. 

The patient was put to bed ; the ulcer of the 
left leg was cleaned antiseptically and hot com- 
presses applied over the ulcerated area every two 
hours, this treatment being continued for 24 
hours. At the expiration of this time soap poul- 
tices were applied twice daily until February 12, 
the day of operation. The evening of the pre- 
vious day the right thigh of the patient was 
shaved, prepared aseptically and soap poultices 
were applied until the time of operation. The 
ulcer of the right leg had been cleansed at the time 
of admission, and sterile dry dressings were then 
applied. It was not intended that both legs should 
be grafted during the same operation, but at the 
time of this operation it was decided that both 
legs should be grafted, which was done accord- 
ingly, grafts being applied not only to the left 
leg, which had been prepared according to usual 
routine, but also to the right leg, which has re- 
ceived no preparation other than the cleansing at 
the time of operation. The Thiersch method was 
employed, both ulcerated surfaces being covered 
with grafts obtained from the right thigh. They 
were then covered with perforated gutta percha, 
and sterile dry dressings employed. 

The dressings were removed in four days. 
Some suppuration had taken place, the surfaces 
being quite moist, and the issue was at this time 
rather doubtful, but at the time of the succeeding 
dressing, five days later, it was found that the 
grafts on both right and left leg had taken kindly ; 
there was no more suppuration, and the areas 
had a healthy pink color. After this dressing the 
gutta percha covering was discontinued, and the 
legs washed daily with sterile normal salt solu- 
tion and alcohol and dressed with smooth sterile 
dressings. 

Healing went forward uninterruptedly until, on 
March 20, the patient, whose general condition 
had become excellent, was discharged "cured," 
all raw surfaces being completely covered over 
by new skin. 



A FURTHER ANTHROPOMETRIC STUDY 
OF ENTEROPTOSIS — REPORTED 
FROM THE CLINIC ON DISEASES 
OF DIGESTIVE ORGANS — PROF. 
JOHN C. HEMAIETER, WITH THE 
HISTORY OF A CASE OF ENTEROP- 
TOSIS, ACCOMPANIED BY AN 
ANTACID GASTRITIS AND MARKED 
ATONY. 



By Albert Hynson Carroll, M.D., 

AND 

Waltf.r C. Bacon (Senior Medical Student). 



The conditions of displaced abdominal viscera 
had been the "Pons Asinorum" of clinicians until 
the brilliant French clinician Glenard began to 
publish his life work on these abdominal states. 

Glenard pulilished his first scholarly researches 
in a journal known as LyoH Mcdicalc in March, 
1885. ("Enteroptose et Neurasthenic.") He has 




Figs. 1 and 2.— T.vpical enteroptic fifi:iii*e. poorly nourished, 
muscular insufficiency. Note small size of thorax as com- 
pared with pelvis, and the \veak abdominal walls. Stomach 
two inches below the umbilicus. Transverse colon prolapsed. 
Nervous symptoms marktd. 

since then published many interesting studies on 
the nervous, physical and chemic abnormalities 
of displaced abdominal viscera. 

It was he who first coined the word "enterop- 
tosis." 

In the year 1853 \'irchow reported autopsy 
findings which led him to argue that in the ma- 
jority of cases they were the result of local peri- 
tonitic processes. It is doubtful if \"irchow ever 



THE HOSPITAL BULLETIN 



89 



reported a case of genuine enteroptosis as Glenard 
conceived it, for these typical cases are congenital, 
and are not accompanied by any evidence of peri- 
tonitis. 

Many prominent European and American ob- 
servers became interested in enteroptosis after 
Glenard's epoch-making publication. The litera- 
ture is too extensive to even cite the more impor- 
tant articles.* 

This literature consists mostly of speculations 
concerning the causes of this intensely interesting 
pathologic state. 

The best contribution was made by Stiller — 
"Die Asthenische Konstitutions krank heiten" — 
in which the first clinical logic is given that prove.s 
this condition to be not simply an abdominal dis- 
placement of the digestive organs, but a distinct 
constitutional anomaly that is inherited, and is 
almost always accompanied by an infirm nervous 
system and a poorly-developed musculature. 

The next most instructive contribution was by 
Hemmeter.t 

For the first time it was here clearly shown 
that enteroptosis could be recognized by the dis- 
proportions of their bony dimensions, and sec- 
ondly, that their hearts, were as a rule, displaced 
also. liemmeter regards enteroptosis as a patho- 
logic product, a sign of a hybrid race, and 
makes interesting biological suggestions concern- 
ing its origin. I 

C.\SE 24,146, UNIVERSITY HOSPITAL DISPENS.\RY. 

Name, J. W. ; age, 22 years ; race, white ; sex, 
male ; social condition, unmarried ; occupation, 
"surveyor's helper." 

Diagnosis. — Antacid gastritis, with gastroptosis 
and marked gastric atony. 

Family History. — This shows us nothing. His 
parents were not blood relatives, as far as he 
knew. There was no history of tuberculosis, can- 
cer, syphilis, gout, rheumatic tendencies or ner- 
vous diseases. Both patients are alive and well. 

Past History. — The patient has had the usual 
diseases of childhood, but has not had typhoid 
fever, appendicitis, any veneral diseases or marked 
gastric disturbances in the past. He states, how- 



*See Hemmeter's tpxtbook on "Diseases of the Stomach." 
and also his two-volume work on "Diseases ot the Intestines. " 

"'Anthropometric Studies of the Osseous Proportions, with 
a View to Obtainlns a Mathematic Expression for Enterop- 
tosis." See R. Smith. "Enteroptosis, With Special Reference 
to Its Etiology and Development," Journal A. it. A., Vol. Iv, 
Xo. 22. 

tSonderabdnck aus : Internationale Beitrage z. Pathologie 
u. Therapie der ErniihrungsstBrungen. Bd. 2. Heft 3. 



ever, that he has had slight attacks of heartburn, 
and has been somewhat constipated at times dur- 
ing the last few years, but that for the last 10 
years he has not been really sick up to the time 
that his present trouble began. He denies any 
venereal diseases. 

Present Illness. — About two months ago, while 
working in the hot sun {he is a surveyor's 
helper), he was suddenly taken sick with severe 
"cramp-like" pains in the epigastric region. He 
did not faint or fall. 

These pains were accompanied with nausea, 
but he did not vomit. He was very miserable for 
several days. Since then, although he has been 
very careful what he eats, the pains have been 
almost constant, although not so severe, regard- 
less of the kind, the amount or the time food is 
ingested. He has not vomited food or blood. 
There has been diarrhea and constipation at va- 
rious times since he was taken sick. 

The epigastric pains are often accompanied 
vv-ith burning pains in the back. (Ulcer was 
thought of, but later findings — absence of free 
HCl., etc. — ruled this out.) He eructates fre- 
quently ; at times some food particles come up, 
and he complains of a lump rising up into his 
throat after eating, of being hungry, but afraid 
to eat on account of the increased distress : of 
great thirst all the time, but he drinks but little 
water, as it "drags like lead" in the region of the 
umbilicus. 

Habits. — He has led a fairly regular life ; denies 
the use of any alcoholic beverages, but has 
smoked inveterately for several years "to quiet 
his nerves." 

The head, mouth and throat show nothing of 
importance. His lungs are negative. The heart 
extends toward the middle line. (Note Hem- 
meter's observations on this point.) 

There were no valvular lesions noted. The 
pulse was regular and of good tone. 

His chest is long and narrow, with two floating 
tenth ribs. 

The subcostal angle also attracts attention ; it 
is only 69°. 

The liver, kidneys and spleen were not palpable. 
The stomach, on dilating with air, reached to 
about two inches below the umbilicus. The trans- 
verse colon was prolapsed also. 

All of the reflexes are normal. There is no 
apparent anemia. The blood was not examined.. 



9fJ 



THE HOSPITAL BULLETIN 



The orthopometric measurements, secondary 
to Hemmeter's original method, are as follows: 



Case No. 




Height .Weight Age-. 

X Angle Pr. Weight 



Patient's measurements are the following: 
Manubrium to xyphoid, 8 inches. 
Manubrium to umbilicus, 15 J4 inches. 
Manubrium to symphisis, 22 inches. 
Xyphoid to right anterior spine, iiJ/> inches. 
Xyphoid to left anterior spine, 11 J/, inches. 
Spine to spine, 10 inches. 
Circumference at xyphoid, 29 inches. 
Angle (sub-costal), 62°. 

(Some other observers, in attempting to arrive 
at similar results, have taken measurements which 
embraeed the fatty portions of the body, i. e., the 
circumference at the level of the pelvic spines, at 
the umbilicus, etc. Hemmeter depends on "fixed 
points of the bony framework" to measure from, 
in much the same way as the obstetrician does 
when he is measuring the female pelvis. A large 
number of athletes at the Baltimore Athletic Club 
and elsewhere, including Cits Schoenline (Ameri- 
cus), the wrestler, and Roy Nelson, the champion 
swimmer, lead one to believe that Hemmeter's 



method is the only correct one. I am of the 
opinion, hozvever, that the patient's height plays 
but a small part. A short man often has a sub- 
costal angle equal to that of a six-footer- In two 
well-developed men the angle, the distance from 
"spine to spine" and the circumference at the 
xyphoid are often the same, regardless of their 
height. Dr. Hemmeter finds that the height of 
the patient is necessary to secure a correct inde.v. 
The small angle, the presence of movable or de- 
tached tenth ribs and the general shape of the 
thoracic cavity, particularly when the distance be- 
tween the tti>o anterior sup. spines is great, should 
call immediate attention to a probable ptosis of 
the abdominal viscera). 

The urine was less than normal in amount 
(probably due to the dilation of the stomach), 
and was negative to albumin and sugar. Sp. gr. 
1020. 

Test lileal. — After withdrawing the usual 
double test meal, free HCl. was found absent. 
Cabbage and beans, eaten 48 hours previously, as 
well as evidences of both test meals, were ob- 
served. The odor was foul. There was not a 
great amount of mucus, and no occult blood. 
Lactic acid tests negative. The "bromine water" 
test failed to give the "tryptophon reaction,'' 
which might have indicated malignancy. Bile 
was absent. 

Feces. — Negative to intestinal parasites or ova. 
Starch granules, bile-stained cellular particles and 
hairs present. Small amount of fat. 

Sputum. — Negative to T. B. 

Treatment. — 

1. Dietary. 

2. Medicinal. 

3. Daily lavage before breakfast. 

4. Electrical (not instituted). 

5. Surgical (not advisable). 

1. Dietary Treatment : The patient was put on 
a "bland diet" ; he was told to avoid all fatty or 
fried foods, and that his food should be taken 
four or five times a day, and that thorough masti- 
cation was most important. Boiled rice, poached 
eggs, boiled fish, spinach, creamed mashed pota- 
toes, milk toast, thin soup, citrous fruits, etc., 
were recommended. 

2. Medical Treatment : Strychnine sulph. gr. 
1/40 t.i.d. before and HCl. dilute gtts. 30 in water 
after meals were given. The bowels were ordered 
kept open with cascara sagrada in case of consti- 
pation. 



THE HOSPITAL BULLETIN 



91 



3. The patient was given a daily lavage with .1 
warm solution of Na. CI. and sodium bicarb, oz. 
I to a quart of water before breakfast for 10 days, 
when a marked improvement was noted. Free 
HCl. 10. Motility was apparently also improved. 

The lavage was continued for five weeks. 

4. Electrical Treatment : This could not be 
instituted, although a Faradic current adminis- 
tered with an intragastric electrode was indi- 
cated to diminish the degree of dilation and as a 
stimulant to secretion and motility. 

5. Surgical interference was thought of, but 
not indicated. A support of abdominal bandage 
would not have helped in this case. 

Patient's Present Condition. — Later, after he 
had been under about two months' treatment, he 
returned to the dispensary for discharge. There 
was a gain in weight. The epigastric pains had 
entirel}' disappeared. K final test meal showed 
free HCl. 10 and no evidence of the first (8.30 
A. l\r.) test breakfast. 

This case illustrates what can be done with 
patience and an obedient patient. It is much to 
be regretted that some means (compulsory meas- 
ures, if you wish) cannot be devised and put into 
execution by which a dispensary patient will be 
required to report at stated periods, and finally 
return for a "discharge." 

A letter from the patient's pastor, or from some 
other reliable source, might be used as an excuse, 
except in emergency cases, but otherwise no way 
presents itself to me just now except to require 
a deposit, say, with the "dispensary physician," 
this to be refunded at the proper time. It is most 
discouraging to have a patient return a month or 
so after receiving temporary relief after three or 
four treatments and to have to start all over 
again. Suggestions would be appreciated. 

"Evergreen," Hampden, Baltimore. 



A CASE OF GASTRIC ULCER WITH 

GASTRO - ENTEROSTOMY 

PERFORMED. 



In our list of the class of 1897, published in the 
June Bulletin, we were unable to locate Dr. W. 
H. Lippett. We are indebted to Dr. A. C. Everett, 
same class, of Rockingham, N. C, for the infor- 
mation that Dr. Lippett died at Pittsborough, 
N. C, about 1900 or 1901. 



Presented by 
Albert H. Carroll, M.D., and Vernon L. Oler 
and Ralph L. Taylor, Class of 191 1, before 
Dr. John C. Hemmeter's Clinic, University of 
Maryland. Operation by J. Holmes Smith, 
M.D. 



Dr. Lay Gordon Burroughs, class of 1906, of 
319 South Aurora street, Collinsville, 111., was a 
recent visitor to the University Hospital. 



Nothing unusual presents itself in this case, 
except, perhaps, the prompt relief afforded by a 
gastro-enterostomy and the patient's rapid con- 
valescence, the operation having been decided 
upon after a brief trial of medicinal treatment, 
under which the patient's condition gradually 
grew worse. His pains became continuous. 

The patient first came under Dr. A. H. Car- 
roll's treatment in the dispensary. Owing to his 
inability to carry out the prescribed treatment at 
his home, he showed no improvement, and he was 
then advised to come into the hospital. He did so. 
patient's history. 

Name, C. H. ; American ; white ; male ; age 42 
years ; single ; occupation "packer." Dispensary 
No- 1728. 

Complaint. — "Pains in the stomach, vomiting 
and loss of appetite." 

Family History. — Father dead ; cause unknov, n. 
Mother dead (tuberculosis, 16 years ago ; he lived 
with her). He denies any history of malignancy, 
nervous, mental, kidney or cardiac diseases in his 
family. 

Past History. — He says that he had measles 
when a child, but that he has never had scarlet 
fever, typhoid fever, pneumonia, malaria or any 
veneral disease. There is no history of trauma. 

Present Illness. — On November 25, 1910, while 
at work the patient experienced severe cramp-like 
pains in his left epigastric region, which radiated 
downward below the umbilicus. He was com- 
pelled to stop work and go home. After a while 
these pains subsided, and he ate a little supper. 
The meal was followed by severe pains, which 
lasted during the entire night- 

On the following day the pains subsided, and 
his condition improved. Two days later he re- 
turned to work, but after two weeks, during which 
time he often experienced these cramp-like pains, 
suffering greatly, vomiting black vomitus, but no 
red blood, he then came to the dispensary for 



92 



THE HOSPITAL BULLETIN 



treatment. The patient was ordered to eat a test 
meal and return the next day at 12 o'clock. The 
contents, after being secured and examined, 
showed free HCl. 40, total acidity 65 ; no blood ; 
some mucus. 

Pulmonary and cardiac examinations show 
nothing pathological. 

Nervous System. — Negative as to diseased con- 
ditions, but the patient is somewhat nervous, al- 
though he is apparently of a cheerful disposition. 
He complained of his inability to sleep, owing to 
the excruciating pains at night. This was the 
main reason for sending him early to operation. 

Genito-urinary Tract. — Negative ; no scars. 

Habits. — It has been impossible to discover any 
vicious habits- He does not drink whiskey and 
but a small amount of beer. He smokes very 
irioderately, and denies using drugs of any de- 
scription. 

Treatment. — The patient was told to go home 
and to go to bed ; to eat nothing, and to drink only 
small quantities of milk at frequent intervals. He 
was given bismuth and alkalies. He returned two 
days later complaining that the pains were almost 
constant, and that he could not retain his medi- 
cine, and that even water made him vomit. He 
says that he had not slept for two nights. His 
pulse at this time was rapid, his skin cold and 
damp and his conjunctiva pale. 

On December 24 Dr. J. Holmes Smith, Sr., ex- 
amined him, and told him that to enter the hospital 
would be advisable. He did so the next day (De- 
cember 25). He was closely observed and given 
medical treatment, under which his pain contin- 
ued, but his vomiting ceased. He was a sick man- 

LABORATORY FINDINGS (aFTER ENTRANCE). 

Stomach Contents. — Free HCl., 50; combined 
acidity, 70; much mucus present, but visible or 
occult blood was absent. 

Urine. — Amount, 1800 c. c. ; amber color; re- 
action acid ; Sp.Gr., 1020 ; albumin negative ; sugar 
negative ; an occasional granular cast. 

Blood. — R. B. C. 4,500,000 
W. B. C. 7,000 



Hbg 



80 



Feces. — Negative to occult blood. 
5'/>m/«»;;.— Negative to T. B. 
A gastro-enterostomy was done January 5 by 
Prof. J. Holmes Smith at this hospital. 

Ol'ERATION. 

The abdomen was opened by an incision four 
inches long and about one inch to the left of the 



median line, above the umbilicus. The stomach 
and intestines were exposed. The bowel was 
caught in an intestinal clamp just beyond the 
duodenal jejunal flexure. An incision was made 
through the meso-colon, and the posterior wall of 
the stomach was made to project through it. The 
stomach was then caught in a clamp, which was 
placed close to the lower border. The clamped 
stomach and intestines were placed side by side, 
the intestines having been turned so as to make the 
peristalic movement of the stomach and intestine 
in the same direction. The serous surfaces were 
united by continued sutures for about 2^^ inches, 
and the two visceral surfaces were then incised 
above the suture. The mucous layers thus ex- 
posed were then sutured with chromic catgut. The 
upper layers were united in a like manner, the 
mucous surfaces being united with chromic catgut 
sutures and the visceral layers by continued silk 
sutures, and the site of anastomosis was rein- 
forced by a strip of omentum sutured around it- 

The patient was returned to his bed. Procto- 
cylysis of half-strength normal saline solution was 
given by Murphy's method, the head of the bed 
being elevated, with the patient in a half-sitting 
posture. 

Twelve hours after the operation an ounce of 
hot water was ordered to be given by the mouth 
every hour. Forty-eight hours after the opera- 
tion the patient enjoyed reading the morning 
paper, experiencing no pain whatsoever, although 
eructations had been persistent previous to the 
operation. He "did not belch" after the opera- 
tion. Flis pulse, temperature and respiration were 
normal. His recovery was uneventful, and he 
was discharged from the hospital on January 18, 
1911. 

PROGNOSIS. 

As to the cure of the gastric ulcer, the prognosis 
is fair, although complications may arise. Per- 
sistent vomiting or "vicious circle" may follow. 
According to some of the latest writers on this 
subject, there is a liability to pancreatic atrophy, 
with its concomitant digestive disturbances, and 
perhaps also the development of neurasthenia. 
Some advise a second operation after the healing 
of the gastric ulcer is complete, doing away with 
the gastro-enterostomy, and thus restoring the 
passage of food through the pyloric orifice into 
the duodenum again. 



•A very similar case, in which surgical Interference was 
postponed, had a severe hemorrhaj-'e in ward "A" last night, 
and died this morning. We must Imow when to operate. 



THE HOSPITAL BULLETIN 



93 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, July 15, 191 1. 

CHARGE AND COLLECT. 
There is, perhaps, no class of the community 
that does as much unselfish and unrequited work 
as the physicians. They spend their days, and 
often their nights as well, in performing laborious, 
irksome, it may be, and frequently unremunerated, 
services. They usually continue to pursue their 
beneficent calling while they are able to work, and 
are generally stricken down with their armor on 
and their blade drawn for the battle. As a rule, 
the physician does not accumulate a large estate, 
and frequently he dies poor and leaves his family 
destitute. This should not be so, and to a large 
extent it is due to the neglect of the doctor in 
observing the most elemental principles of busi- 
ness. While the poor are ever with us, and it is 
proper to render gratuitous services to such as are 
in distress and poverty, nevertheless one should 
not get into the habit of working without com- 
pensation. The first principle of medical business 
should be the regular, frequent rendering of bills 
to those who are able to pay, remembering that it 
is easier to pay a small fee than a large one, and 
not waiting until the aggregate is large and per- 
haps burdensome. The professional charge 
should not be too small. There is a vast difference 
between the average fees of the lawyer and those 
of the physician. The lawyer expects a fee com- 
mensurate with the work done, and he usually 
gets it. On the other hand, the doctor usually 
charges ridiculously low rates for his services, and 
he does not collect what he charges. The people 
respect the successful lawyer, and pay him; they 
love the old family doctor, and let it go at that, if 
they can. The second rule of medical business, 
then, should be, collect vour bills from those who 



are able to pay, or let them go elsewhere when 
they fall sick. This will, of course, be somewhat 
difficult, but when your clientele thoroughly under- 
stand that you are in earnest in demanding just 
and regular compensation, they will comply. The 
physician is a mark for all kinds of sharpers, and 
he is solicited to invest his money in all kinds of 
wild-cat enterprises. It is a good thing for the 
doctor when he begins to make more than his ex- 
penses to buy a home and furnish it, or, if living, in 
the country, to purchase a farm. Whether living 
in the country or in the city, it is best for him to 
invest in some solid security, real estate, mort- 
gages, ground rents or attested bonds, rather than 
in speculative undertakings. The royal road to 
competence and to wealth is to spend less than you 
make. It is not what one makes that tells, but 
what one spends. The writer had no idea of in- 
flicting this homily upon anyone when he began 
this article, neither is he a brilliant exponent of 
the efficacy of the principles enunciated above ; 
however, he makes no charge for the advice given, 
and the turning loose of another class of gradu- 
ates affords an opportunity for reflections and 
suggestions. 



LOUIS McLANE TIFFANY. 
Those of us who have had the pleasure of lis- 
tening to the charming and instructive lectures 
of Prof. Louis McLane Tiffany will be glad to 
learn that our friend and former teacher has suf- 
ficiently recovered from his recent illness to leave 
for his daughter's home on the coast of Massa- 
chusetts. Dr. Tiffany was an ornament to the 
School, and his serv'ices were invaluable. Those 
who kno^ him would deeply regret to learn that 
any misfortune had befallen him. His former 
colleagues, friends and students unite in wishing 
him a speedy return to his former good health. 



WATCH IT GROW. 
The following contributions have been made 
to the endowment fund of the department of path- 
ology to July I : 

Robinson bequest $5,000 00 

Dr. Hugh Hampton Young, J. H. U. . . 100 00 
Dr. S. J. Meltzer, LL.D., New York. . . 10 00 

Dr. Gideon Timberlake 25 00 

:S[r. H. P. Ohm 10 00 

Dr. Samuel W. Moore, D.D.S 25 00 

Hospital Bulletin 5 00 



94 



THE HOSPITAL BULLETIN 



Maryland Medical Journal 5 OO 

Miss C. M. Selfe 5 oo 

Prof. R. Dorsey Coale, Ph.D lOO oo 

Dr. John J. R. Krozer, 1848 50 00 

Dr. Eugene F. Cordell, 1868 10 00 

Dr. Joseph T. Smith, 1872 10 00 

Dr. W. J. Young, 1872 25 00 

Dr. Thomas A. Ashby, 1873 100 00 

Dr. David W. Bulluck, 1873 100 00 

Dr. Robert Gerstell, 1873 5 00 

Dr. Randolph Winslow, 1873 100 00 

Dr. H. T. Harrison, 1874 5 00 

Dr. Charles W. Mitchell, 1881 100 00 

Dr. J. M. Hundley, 1882 250 00 

Dr. Henry Chandlee, 1882 10 00 

Dr. B. Merrill Hopkinson, 1885 25 00 

Dr. H. C. Reamer, 1885 10 oo 

Dr. Frank Martin, 1886 100 00 

Dr. C. W. McElfresh, 1889 100 00 

Dr. Harry Adler, 1895 lOO 00 

Dr. Jose L. Hirsh, 1895 50 00 

Dr. Joseph W. Holland, 1896 50 00 

Dr. R. W. Sturgiss, 1896 2 00 

Dr. L. W. Armstrong, 1900 10 00 

Dr. S. Demarco, 1900 50 oo 

Dr. M. S. Pearre, 1900 5 00 

Dr. J. D. Reeder, 1901 50 00 

Dr. Nathan Winslow, 1901 50 00 

Dr. Arthur M. Shipley, 1902 250 00 

Dr. H. C. Davis, 1902 10 00 

Dr. Hugh Brent, 1903 25 00 

Dr. G. C. Lockard, 1903 25 00 

Dr. Geo. S. M. KieflFer, 1903 25 00 

Dr. H. J. Maldeis, 1903 25 00 

Dr. R. C. Metzel, 1904 10 00 

Dr. Robert P. Bay, 1905 100 00 

Dr. W. F. Sowers, 1906 25 00 

Dr. Frank S. Lynn, 1907 25 00 

Dr. E. H. Kloman, 1910 25 00 

Thomas C. Basshor Company.. 10 00 



$7,207 00 



ITEMS 

Among the older alumni of the University are : 

John W. C. O'Neill, 1844, Gettysburg, Pa. 

R. Pinkney Blackistone, 1849, River Springs, 



Md. 



William G. Wilson, 1852, Shelby ville, 111. 
James K. Waters, 1859, Thurniont, Md. 



John J. R. Krozer, 1848, 662 West Lexington 
street, Baltimore, Md. 

Roland H. Walton, 1850, Annapolis, Md. 

Henry M. Wilson, 1850, 1018 Madison avenue, 
Baltimore, Md. 

J. H. Jarrett, 1852, Towson, Md. 

Philip S. Field, 1852, 805 North Fulton avenue, 
Baltimore, Md. 

Thomas B. Owings, 1852, Ellicott City, Md. 

Wni. E. Magruder, 1854, Sandy Spring, Md. 

E. Tracy Bishop, 1855, Smithsburg, Md. 

Joshua W. Hering, 1855, Westminster, Md. 

John D. Cronmiller, 1856, Laurel, Md. 

James H. Butler, 1857, 1508 Linden avenue, 
Baltimore, Md. 

J. Ford Thompson, 1857, The Rochambeau, 
816 15th street N. W., Washington, D. C. 

Benjamin F. Price, 1857, Mount Carmel, Md. 

Samuel C. Chew, 1858, Roland Park, Md. 

Nathaniel G. Kierle, 1858, 1419 West Lexing- 
ton street, Baltimore, Md. 

Edw. F. Milholland, 1858, 115 West Franklin 
street, Baltimore, Md. 

Somerset R. Waters, 1858, Watersville, Car- 
roll county, Maryland. 

Robert A. Dodson, 1859, St. Michaels, Md. 

Theodore Cooke, Sr., 1859, 914 North Charles 
street, Baltimore, Md. 

Benjamin L. Smith, 1859, Madison, Md. 

Ephraim Hopkins, T859, Darlington, Md. 

James G. Linthicum, 1859, 1327 West Fayette 
street, Baltimore, Md. 

Samuel Ouinn, 1859, Pocomoke, Md. 

Henry L. Naylor, i860, Pikesville, Md. 

John H. Coonan, 1861, 1610 Guilford avenue, 
Baltimore, Md. 

Edw. R. Woolen, 1861, Poolesville, Md. 

Charles M. Morfit, 1861, 208 McMechen street, 
Baltimore, Md. 

Thomas B. Wilson, 1861, Edesville, Md. 

John R. Uhler, 1861, McCuUoh and Mosher 
streets, Baltimore, Md. 

Charles W. Goldsborough, 1862, Walkersville, 
Md. 

John H. Bolton, 1862, 1120 North Gay street, 
Baltimore, Md. 

John C. Harris, 1862, yjT, West Lexington 
street, Baltimore, Md. 

W. B. Wheeler, 1862, Boonsboro, Md. 

Wilbur P. Morgan, 1862, 315 West Monument 
street, Baltimore, Md. 

Charles A. Wells, 1862, Hyattsville, Md. 



THE HOSPITAL BULLETIN 



95 



John H. Chew, 1863, 23 Astor strcel, Chi- 
cago, 111. 

Edw. R. Trippe, 1862, Easton, Md. 

Alex. H. Saxton, 1863, 1136 West Lexington 
street, Baltimore, Md. 

James Watt, 1863, Union Bridge, Md. 

George H. Brown, 1864, New Windsor, Md. 

John F. B. Weaver, 1864, Manchester, Md. 

Martin L. Jarrett, 1864, Jarrettsville, Md. 

Wm. H. Stone, 1864, Hollywood, St. Mary's 
county, Maryland. 

Henry C. Richardson, 1864, Great Mills, Md. 

James H. Billingslea, 1864, Westminster, Md. 

Joseph A. Mudd, 1864, Hyattsville, Md. 

Geo. H. Cairnes, 1864, 21 West 25th street, 
Baltimore, Md. 

Luther M. Zimmerman, 1864, Hagerstown, Md. 

E. Miller Reid, 1864, 904 North Fremont ave- 
nue, Baltimore, Md. 

Frank T. Shaw, 1864, Westminster, Md. 

Daniel E. Stone, 1864, Mt. Pleasant, Aid. 

John T. Yourtee, 1865, Brownsville, Md. 

Geo. W. Betson, 1865, Greensboro, Md. 

G. Lane Taneyhill, 1865, 1103 Madison avenue, 
Baltimore, Md. 

Richard W. Trapnell, 1866, Point of Rocks, 
Md. 

John T. King, 1866, 1425 Eutaw place, Balti- 
more, Md. 

John R. Hooper, 1866, Commonwealth Bank, 
Baltimore, Md. 

John A. Skinner, 1866, U. S. A. 

L. W. Knight, 1866, 414 South Greene street, 
Baltimore, Md. 

Robert J. Henry, 1866, Glyndon, Md. 

O. M. Muncaster, 1866, The Rochambeau, 
Washington, D. C. 

G. G. Rusk, 1867, 2000 East Baltimore street, 
Baltimore, Md. 

James W. Gore, 1867, Reisterstown, Md. 

H. T. Rennolds, 1867, 2004 St. Paul street, Bal- 
timore, Md. 

Silas Baldwin, 1867, 700 West Lafayette ave- 
nue, Baltimore, Md. 

Joseph S. Raborg, 1867, 1202 West Mt. Royal 
avenue, Baltimore, Md. 

Junius L. Powell, 1867, U. S. A. 

Benjamin R. Davidson, 1867, Davidsonville, 
Md. 

Samuel Theobald, 1867, Cathedral and Howard 
streets, Baltimore, Md. 

Young H. Bond, 1867, St. Louis, Mo. 



B. B. Browne, 1867, 510 Park avenue, Balti- 
more, A-Id. 

E. F. Cordell, 1868, 257 West Hoffman street, 
Baltimore, Md. 

J^ichard T. Gott, 1868, Poolesville, Md. 

Pierre G. Dausch, 1868, 124 Jackson street, 
Baltimore, Md. 

Frank Slingluff, 1868, 1702 North Calvert 
street, Baltimore, Md. 

Edw. H. Holbrook, 1868, 728 North Carey 
street, Baltimore, Md. 

L. McL. Tiffany, 1868, 831 Park avenue, Balti- 
more, Md. 

Wm. J. Newbill, 1868, Irvington, Va. 

John H. Grimes, 1868, 1 14 East 21st street, Bal- 
timore, Md. 

J. G. Hollyday, 1868, 714 Frederick avenue ex- 
tended, Baltimore, Md. 

John L. Waring, 1868, Clinton, Md. 

James H. Wilson, 1868, Fowblesburg, Md. 

James R. Phillips, 1869, Preston, Md. 

Charles B. Boyle, 1869, Hagerstown, Md. 

J. McHenry Howard, 1869, Baltimore, Md. 

Major Louis W. Crampton, 1869, U. S. A. 

Geo. Wythe Cook, 1869, 3 Thomas circle, 
Washington, D. C. 

W. H. H. Campbell, 1869, Owings Mills, Md. 

John J. Ligget, 1869, Ladiesburg, Md. 

W. J. Lumsden, 1869, Elizabeth City, N. C. 

J. H. Hartman, 1869, 5 West Franklin street, 
Baltimore, Md. 

John I. Pennington, 1869, The Marlborough, 
Baltimore, Md. 

Zachary D. Ridout, 1869, St. Margaret's, An- 
napolis P. O., Md. 

Joseph A. White, 1869, Richmond, Va. 

James G. Wiltshire, 1869, 819 Eutaw street, 
Baltimore, Md. 

A. Trego Shertzer, 1869, 25 West Preston 
street, Baltimore, Md. 

Samuel H. Anderson, 1870, Woodwardville, 
Md. 

Boiling W. Barton, 1870, Virginia. 

Samuel T. Earle, 1870, 143 1 Linden avenue, 
Baltimore, Md. 

T. Marshall Jones, 1870, Alexandria, Va. 

Richard H. Speight, 1870, Whitakers, N. C. 

James S. Spiller, 1870, King William, Va. 

Frederick Straughn, 1870, Gaston place, Jersey 
City, N. J. 

Geo. L. Wilkins, 1870, 6 North Broadway, Bal- 
timore, Md. 



96 



THE HOSPITAL BULLETIN 



Henry A. Zeigler, 1870, 349 West Market 
street, York, Pa. 

J. P. Cheney. 1870, Breathedsville. Md. 



The following letter has been received from 
Dr. J. C. Perry of Ancon, Panama, in response to 
an appeal from the class of 1885 for aid towards 
the endowment of the pathological department: 

June 8, 191 1. 

Dear Doctor: I beg to acknowledge receipt of 
your letter of April 11, relative to the alumni 
contributing towards the fund of $100,000 that 
the Faculty of Medicine of the University of 
Maryland are trying to raise for the endowment 
of a Department of Pathology. Your letter 
would have been acknowledged before this except 
for the fact that I have been away and have only 
recently returned. 

I am not quite positive what would be a proper 
amount to subscribe to the fund, and not having 
acquired any vast sum of money during my pro- 
fessional career (although no doubt my financial 
condition is better than some that have gradu- 
ated), I am assuming that if each alumnus sub- 
scribed $100 it ought to materially assist the 
fund, and I am perfectly willing and glad to give 
this amount. 

As well as I remember, there were 80 or 90 in 
our class, and in all the time that I have traveled 
around the United States and through several 
foreign countries in my service position I have 
not met one. I am sorry for this, especially so as 
I knew a number of the internes who were house 
students at the same time that I was very well, 
and if you have been able to compile a list of our 
class, with addresses, I would appreciate it very 
much if you would send me a copy. 

Very sincerely, 

J. C. Perry. 

The list of the class, which was published in 
the April Bulletin, has been sent to Dr. Perry. 



The annual reunion and banquet of the Alumni 
Association of the University of Maryland 
School of Medicine was held at the Eutaw House 
June I, 191 1. The retiring president. Dr. G. 
Lane Taneyhill, class of 1865, presided and intro- 
duced the speakers. The Mayor had promised to 
be present, but being unable to keep the engage- 
ment, sent in his stead Mr. James F. Thrift, City 
Comptroller, who spoke from the point of view 
of the Health Department. Dr. Eugene A. 



Noble, who has just retired as president of 
Goucher College, gave an interesting address, 
with "Personal Experiences as a Co-worker with 
Doctors in a City Hospital" as his subject, and 
Dr. Charles Fiske, rector of St. Michael's and All 
Angels' Protestant Episcopal Church, spoke upon 
"The Moral Aspects of a Physician's Work." 
The toast to the class of 191 1 was answered by 
Dr. Willis Linn, president of the class. Mr. Ho- 
bart Smock entertained with recitations and anec- 
dotes, and later joined with Dr. Hopkinson in 
vocal selections. 

The following officers were elected for the en- 
suing year : 

President, Charles E. Sadtler, class of 1873. 

Vice-presidents, George H. Stewart, class of 
1899; Marshall West, class of 1901, and Samuel 
T. Earle, class of 1870. 

Recording Secretary, Nathan Winslow, class 
of 1901. 

Assistant Recording Secretary, William S. 
Love, class of 1890. 

Corresponding Secretary, John I. Pennington, 
class of 1869. 

Treasurer, John Houff, class of 1900. 

Executive Committee, Drs. G. Lane Taneyhill, 
class of 1865 ; Charles R. Winterson, class of 
1871 ; B. Merrill Hopkinson, class of 1885; 
George A. Fleming, class of 1884, and Vernon 
L. Norwood, class of 1885. 



Dr. Charles W. McElfresh, class of 1889, is 
confined to his home with a sprained ankle. 



The honorary degree of master of arts was con- 
ferred upon Dr. Eugene Lee Crutchfield, class of 
1887, by St. John's College on Commencement 
Day, June 21, 191 1. 



Dr. T. Marshall West, class of 1908, of Fay- 
etteville, N. C, was a recent visitor to the Uni- 
versity Hospital. 



Mayor James H. Preston has appointed Dr. 
Albert Tyler Chambers, class of 1898, a member 
of the School Board of Baltimore city, and the 
appointment has been confirmed by the City Coun- 
cil. Dr. Chambers was born in Virginia Febru- 
ary 9, 1876, the son of Benjamin and Rachael 
Tyler Chambers. He was educated in the public 
schools of Virginia and the Randolph-Macon 
Acadcnn'. He later took a course at Eaton & 



THE HOSPITAL BULLETIN 



97 



Burnett's Business College, graduating there. He 
received his degree of M.D. from the LIniversity 
of Mar3'land in 1898, graduating with highest 
honors, and winning, besides the University, the 
practice of medicine gold medal. Dr. Chambers 
is prominently connected with various profes- 
sional and other institutions, and from 1900 to 
1905 held the office of City Vaccine Physician. 
He is now professor of operative and clinical 
surgery at the Maryland Medical College. Dr. 
Chambers has a large private practice and is one 
of the best known of our younger alumni. The 
brilliant promise made in his student years has 
not gone unfulfilled. Dr. Chambers married on 
June 5, 1905, Miss Marguerite Linthicum. We 
consider the choice of the Mayor wise, and feel 
that the city can secure no man more well rounded 
or one who could better serve it on the School 
Board than Dr. Albert T. Chambers. 



The following letter has been received by Prof. 
Randolph W'inslow from Dr. Michel Hanna, 
class of 1910, of Tanta, Egypt : 

"Tanta, Egypt, June 16, 191 1. 

"Dear Professor Winslow — It gives me much 
pleasure to write you again. It makes me feel as 
if I were in close contact with the LTniversity and 
its people, notwithstanding the thousands of miles 
that separate us. I recall the good time I had in 
Baltimore, both in and outside the University. 
Everything went on nicely. Give my regards to 
Dr. Bay. I will write to him next week. 

'T would like to tell you of a few operations I 
performed recently. One of them was an internal 
podalic version for a transverse presentation ; a 
herniotomy for a strangulated scrotal hernia ; 
operation for a prolapsus recti, with external hem- 
orrhoids, in an old woman ; a radical operation for 
trichiasis by removing an elliptical piece of the 
cartilage, and a few other ones, such as hemor- 
rhoids, suppurative mumps, etc. I succeeded in 
all of them except the prolapsus recti case, which 
recurred soon, though the woman is relieved from 
the pain caused by the external hemorrhoids. 

"The case of strangulated hernia came to me 
48 hours after the first symptom of strangulation. 
He had nausea, persistent vomiting, abdomen 
slightly ballooned and painful, pulse rate 120 and 
very feeble. I did it with George (George is Dr. 
George Hanna, class of 1901). I was astonished 
to meet a gush of fluid at the opening of the sac 
proper. 1 drained much of it and returned the 



bowels in the abdominal cavity after some hesita- 
tion, as they were highly congested. I thought of 
resorting to Murphy's button, especially as they 
were ready at hand ; but, trusting to nature, I 
closed the layers according to Basini and had a 
perfect cure in 17 days. I used the ice cap on the 
abdomen right after the operation. The man was 
discharged in 17 days. I then remembered what 
you once said, answering my question in the 
amphitheater, T can do an aseptic operation even 
in Egypt.' 

"The case of internal podalic version was in 
the country where decapitation seemed to me im- 
possible and not without much danger. I gave 
the woman chloroform, using my handkerchief as 
a mask. When she was under, I turned over the 
anesthetic to the husband — an old farmer — and 
began the operation. I must say that twice I felt 
that I got 'stung.' But in a third trial of search- 
ing I got hold of the desired foot and thus com- 
pleted the operation. I never thought the opera- 
tion was so tiresome. My arm hurt me for four 
days. 

"After all, I would like to say a few words 
about chloroform. I am inclined to believe either 
that the dangers of chloroform are very highly 
exaggerated or else the people of this country 
have a peculiar resistance against its dangers. 
They stand it well and practically without danger. 
I never thought before that the old woman with 
the prolapsus recti or the case of herniotomy, bad 
as it was, could stand chloroform. Chloroform 
is very advantageous in private practice. The 
patient sleeps in three minutes, with practically 
no kicking whatever. Vomiting, too, is exceed- 
ingly rare. 

"George left for Europe last week via Con- 
stantinople. I am sure you will hear from him. 

"I must stop now ; a longer letter would bother 
you if this doesn't. 

"Kindly offer my sincere regards to our hon- 
orable faculty, Drs. Winslow, Jr., Mr. Johnson, 
and to everybody that smells University of Mary- 
land. "Sincerely yours, 

"Michel S. PIanna." 



Dr. William Joseph Coleman, class of 1908, has 
been appointed superintendent of the LIniversity 
Hospital, vice Dr. Piggott, resigned. 



Dr. G. W. Betson, class of 1865. is located at 
Greensboro, Md. ; Dr. G. Lane Taneyhill, of the 



98 



THE HOSPITAL BULLETIN 



same class, in Baltimore, Md., and Dr. John T. 
Yourtree, also of the class of 1865, is at Browns- 
ville, Md. 



Dr. Sydenham Rush Clarke, class of 1905, has 
removed his office and residence to 423 Hawthorn 
road, Roland Park, Md. 



Of the 44 physicians who graduated in 1870, 
there are apparently only the following 10 now 
living : 

Samuel H. Anderson, Woodwardsville, Md. 

Boiling W. Barton, Va. 

Samuel T. Earle, 143 1 Linden avenue, Balti- 
more, Md. 

T. Marshall Jones, Alexandria, Va. 

Richard H. Speight, Whitakers, N. C. 

James S. Spiller, King William, Va. 

Frederick Straughn, 9 Astor place, Jersey City, 
N.J. 

George L. Wilkins, 6 North Broadway, Balti- 
more, Md. 

Henry A. Zeigler, 349 West Market street, 
York, Pa. 

John L. Shock, Shippenburg, Pa. 



Dr. James Edward Benson, class of 1884, of 
Cockeysville, Md., was a recent visitor to the Uni- 
versity Hospital. 



A partial record of the class of 1865 is as fol- 
lows : 

John R. Hooper, Baltimore, Md. 

Robert J. Henry, Glyndon, Md. 

John T. King, Baltimore, Md. 

Louis W. Knight, Baltimore, Md. 

O. M. Muncaster. The Rochambeau, Washing- 
ton, D. C. 

John O. Skinner, Surgeon-General's Office, 
Washington, D. C. 

Richard W. Trapnell, Point of Rocks, Md. 



Dr. Charles W. Mitchell, class of 1881, has re- 
moved his office to 9 East Chase street, for many 
years the residence of tlie late William Pinckney 
White. 



BIRTHS 
Dr. George Carroll Lockard, class of 1903, of 
1 63 1 West Lafayette avenue, and Mrs. Lockard 
are receiving the congratulations of their friends 
upon the birth of a daughter. 



Dr. Walter Franklin Sowers, class of 1906, of 
23 1 1 Edmondson Terrace, and Mrs. Sowers are 
being congratulated upon the advent of a daugh- 
ter during the month of June. 



DEATHS 

The following alumni have died during the year 
ending June i, 191 1 : 

John W. Hebb, class of i860, in Howard 
county, Maryland, May 18, 1910, aged 71. 

John H. Stemple, class of 1901, at Consho- 
hocken. Pa., April 19, 1910, aged 33. 

Henry VV. Fishel, class of 1886, at Harrisburg, 
Pa., May 9, 1910, aged 58. 

Henry U. Onderdonk, class of 1873, at Bufifalo, 
Wyo., May 11, 19 10, aged 60. 

Jesse W. Downey, class of 1869, at New Mar- 
ket, Pa., June 29, 1910, aged 62. 

Nathaniel R. Gerry, class of 1864, at Baltimore, 
Md., July 2, T910, aged 78. 

Claude Van Bibber, class of 1877, at Baltimore, 
Md., July II, 1910, aged 57. 

Kenneth A. Blue, class of 1889, at Laurinsburg, 
N. C, July 16, 1910, aged 43. 

Frank Camm, class of 1885, at Lynchburg, Va., 
August 5, 1910, aged 62. 

Frank A. Gavin, class of 1874, at Baltimore, 
Md., August 24, 1910, aged 55. 

John A. McLaughlin, class of 1888, at Clarks- 
burg, Va., August 19, 1910, aged 50. 

Martin L. Fittro, class of 1896, at New Mar- 
tinsville, W. Va., August 12, 1910, aged 45. 

James R. Crockett, class of 1891, at Baltimore, 
Md., August 2, 1910, aged 54. 

Marshall J. Brown, class of 1907, at Baltimore, 
Md., September 4, 19 10, aged 27. 

John W. Dashiell. class of 1843, ^t Princess 
Anne, Md., September 4, 1910, aged 93. 

William W. Sanders, class of 1861, at La Plata. 
Md., October 6, 19 10. 

Geo. C. Worthington, class of 1866, at Alber- 
ton, Md., October 23, 1910. 

B. Frank Whiteside, class of 1877, at Salisbury, 
N. C, October, 1910, aged 58. 

Jose L. Romero, class of 1879, at Jacksonville, 
Fla., October 14, 1910, aged 57. 

Charles D. Eichelberger, class of 1868, at Eni- 
mitsburg, Md., October 19, 1910, aged 75. 

Walter H. Fenby, class of 1894, at Ruthsville, 
Md., November 5, 1910, aged 40. 

John T. Wilkins, Sr., class of 1851, at Cape 
Charles, Va., November 16, 1910, aged 90. 



THE HOSPITAL BULLETIN 



99 



David L. Magruder, class of 1849, at Biyn 
Mawr, Pa., November 22, 1910, aged 85. 

Thomas M. Chaney, class of 1866, at Chaney, 
Md., December 6, 1910, aged 68. 

Berwick B. Lanier, class of 1892, at Baltimore, 
Md., Jamiary i, 191 1, aged 41. 

Edward Lacy Gibson, class of 1894, at Staun- 
ton, Va., January 6, 191 1, aged 41. 

Thomas Harris Cannon, class of 1901, at Balti- 
more, Md., January 29, 191 1, aged 31. 

Charles E. O'Neill, class of 1867, at Harris- 
burg, Pa., December 21, 1910, aged 69. 

Fenwick Robertson, class of 1854, at Pikesville, 
Md., January 31, 191 1, aged 81. 

David M. Devilbiss, class of 1872, at Woodville, 
Md., February 14, 191 t, aged 66. 

George W. Mahle, class of 1905, at Baltimore, 
Md., February 20, 191 1, aged 29. 

Hiram W. Harding, class of i860, at Northern 
Neck, Va., March 24, 191 1, aged 72). 

Jonathan A. C. Hower, class of 1854, at Mar- 
tinsburg, W. Va., March 28, 191 1, aged 84. 

Adolph G. Hoen, class of 1873, at Baltimore, 
Md., March 29, 191 1, aged 62. 

Jacob Dimmitt Norris, class of 1878, at Balti- 
more, Md., April 24, 191 1, aged 67. 

FredA-ick C. Baker, class of 1888, at East Nor- 
walk, Conn., April 18, 191 1, aged 55. 

George H. Hafele, class of 1908, at Baltimore, 
Md., May 3, 191 1, aged 32. 

Cameron Piggott, class of 1882, at Sewanee, 
Tenn., April 30, 191 1, aged 55. 

Reuben A. Wall, class of 1904, at Catonsville, 
Md., May 4, 191 1, aged 34. 

Norman F. Hill, class of 1882, at Baltimore, 
Md., May 12, 191 1, aged 64. 

John R. T. Reeves, class of 1858, at Chaptico, 
Md., April 24, 1911, aged 79. 

Richard Sappington, class of 185 1, at Balti- 
more, Md., May 14, 191 1, aged 84. 

Robert Atkinson, class of 1854, at Baltimore, 
Md., May 22, 191 1, aged 79. 



Edwin G. Darling, M.D., class of 1882, died at 
his home at Lauraville, Md., June 6, 191 1, of con- 
sumption, aged 52 years. Dr. Darling was born 
in Baltimore county, Maryland, and was the son 
of the late Isaac and Anna Darling. He had been 
practicing at Lauraville for about 30 years, and 
was well known in the vicinity. He is survived 
by his widow, Mrs. Virginia Darling, who was 
formerly Mrs. Fox, and who is a daughter of 



the late George Shimer of Winchester, Va. 
Dr. Darling's body was taken to Winchester Fri- 
day morning, June 9, for burial. Funeral services 
were held at Lauraville Thursday evening, June 
8, and Rev. J. M. MuUan of St. Mark's Reformed 
Church of Baltimore, and Rev. J. J. Ringer of 
Andrew Chapel, Franklin avenue, officiated. 



Stephen Harrison Griffith, M.D., class of 1890, 
of Greenwood, S. C, died at Gaftney, S. C, May 
13, 191 1, of heart disease, aged 44 years. 



Van E. Delashmutt, M.D., class of 1854, died 
at his home in Shelburn, Ind., May 25, 191 1, aged 
79 years. 



Theodore H. BeUz, M.D., class of 1863, died at 
his home, 320 South George street, York, Pa., 
May II, 191 1, from nephritis, aged 69 years. 



Dr. Robert Atkinson, class of 1854, died at his 
home, 2105 Oak street, Baltimore, May 22, 191 1, 
of pneumonia, after an illness of three days. 

Dr. Atkinson had been in feeble health for some 
time, and spent last winter in Florida, returning 
to this city two weeks ago. Friday he contracted 
pneumonia, and, owing to his impaired vitality, 
was unable to battle against the disease. 

Graduated in medicine at the University of 
Maryland, he practiced a few years, then founded 
a private school, which bore his name and which 
in its time was a well-known institution, ranking 
with the more prominent ones of Baltimore. His 
father, when Dr. Atkinson was yet a child, was 
rector of old St. Peter's Church, later founding 
Grace Church, of which Rev. Dr. Arthur Chilton 
Powell is now rector. 

From his youth Dr. Atkinson had been a great 
church worker. He was a vestryman of Grace 
Church under the rectorship of his father, then 
Rev. Thomas Atkinson. He was a member of the 
diocesan committee of missions, and for a number 
of years had been a delegate to the Maryland 
Diocesan Convention. He was a student and a 
recognized authority upon questions pertaining to 
the Episcopal Church. 

From 1859 until 1891 Dr. Atkinson conducted 
a private school for boys at Madison and Eutaw 
streets, in the building now occupied by the Jor- 
dan Stabler Company. Among his pupils were 
many men who have helped to build the modern 



lOO 



THE HOSPITAL BULLETIN 



commercial and financial structure of Baltimore, 
and from his old "bo_\'s" were selected his pall- 
bearers. He was born in Lunenburg county, Vir- 
ginia, in December, 1831, coming to Baltimore 
with his parents in 1843. 

Dr. Atkinson was twice married. His first wife 
was Miss Georgianna Keerl of this city. Of this 
marriage was born a son, Rev. Thomas Atkinson, 
and a daughter, Mrs. Thomas M. Nelson of 
Roland Park, both living. Mr. Atkinson is now a 
canon of the Episcopal Cathedral, in the chapel of 
which the congregations of the two churches of 
which he had been rector — Sts. Barnabas and 
George's — will worship. Dr. Atkinson's second 
wife, to whom he was married in 1874, survives 
him. She was Miss Laura Randall Robinson, also 
of this city. There were no children by this mar- 
riage. 

For a half century or more Dr. Atkinson had 
kept in close touch with the aiTairs of Baltimore 
and in intimate personal relationship with many 
of the city's foremost men. Since his retirement 
from active life he found reading one of his chief 
forms of recreation. Another amusement of which 
he was particularly fond was chess. He was a 
member of a chess club, now disbanded, composed 
of many well-known FJaltimoreans with kindred 
tastes. 



Atlanta Tech. and Ben Jones Gantt, and one sis- 
ter. Miss Annie Gantt. 



We regret exceedingly to announce the death 
of Lieut. Robert H. Gantt, M.D., class of 1909, 
on June 10, 191 1, at Fort Sam Houston, Texas. 
Dr. Gantt was born in ilacon, Ga., January 12, 
1884, the son of Mr. and Mrs. George W. Gantt, 
421 Orange street. He attended the public schools 
of Macon and graduated from Emory College in 
1902. He attended the Atlanta Medical College 
for two years and then spent two years in Macon 
as a prescription clerk with two well-known drug 
houses of that city. In 1905 he entered the Uni- 
versity of Maryland, graduating in 1909. He then 
spent a year as interne in a Baltimore hospital 
and was afterwards appointed to the Soldiers' 
Home. Just a year ago he was assigned to the 
Medical Corps, U. S. A., and when the troops 
were ordered to Texas he was stationed at Fort 
Sam Houston. Death was due to a nervous 
breakdown. Dr. Gantt was well known and much 
liked in Macon, and the news of his death was 
received with deepest regret. He was buried in 
Macon. He is survived by his parents, three 
brothers, George ^^^ Gantt. Jr., J. A. Gantt of the 



G. E. Milton Smith, M.D., class of 1888, of 594 
Presstman street, Baltimore, died at the Church 
Home and Infirmary May 22, 191 1, aged 43 years. 
Dr. Smith is survived by his widow, Mrs. Mar- 
garet M. Smith. He was buried from Christ 
Church, Baltimore, at 4.30 P. M. Tuesday, May 
23, 1911. 



LABORATORY REPORT OF THE UNI- 
VERSITY HOSPITAL. 
Month of June. 
Blood Examinations. 

Leucocyte counts 1 58 

Erythrocyte counts 24 

Differential leucocyte counts 10 

Hemoglobin determinations 81 

Smears for malarial parasites 10 

Blood cultures c 

Wasserman tests 41 

W'idal tests 1 1 

340 

Uniic Examinations. 

Routine urinalysis (chemical and micro- 
scopic) 395 

Total estimation for urea 4 

Total estimation for albumen 5 

Total estimation for sugar 4 

• 408 

Miscellaneous. 
Gastric contents (chemical and micro- 
scopic) II 

Feces (microscopic, etc.) 10 

Sputum examination 15 

Bacteriological cultures and smears 

(from operative cases) 10 

Smears from vagina and urethra (male). 12 

.Spinal fluid examination 2 

Pleural fluid examination 3 

Autopsies 2 

Section of tissue for microscopic ex- 
amination 11^ 

^ 80 

Total S28 

Dr. J. L. HiRSH, 
Dr. H. J. Maldeis, 
Dr. R. C. DoDSOiV, 
W. M. ScoTf. 



i 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE fl.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-ofBce 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., AUGUST 15, 1911. 



No. 6 



THE REL.\TIVE VALUE OF CECOSTOAFY 
.AND APPENDICOSTOMY IN THE 
TREATMENT OF AMEBIC DYSEN- 
TERY AND OTHER DISEASES AF- 
FECTING THE MUCOUS LINING OF 
THE CECUM AND COLON, WITH 
REPORT OF CASE. 



By RicH.\KD C. DoDSON, 'ir, 
Senior Medical Student. 



After carefully .searching the medical literature 
I find that Prof. Samuel Goodwin Cant of New- 
York was the originator of the operation which, 
for the want of a better name, he called "Cecos- 
tomy." This was in 1903. I also found that dur- 
ing the same year Holton C. Curl, M.D., U. .S. .\., 
surgeon at Colon Hospital, reported a few cases 
in the Annals of Surgery. \'o\. LXIII, p. 543. 

The operation of cecostomy for amebic d_vsen- 
^ery is not always advisable, especially in the late 
cases where there is prostration and great dam- 
age to the mucous membrane and subnuicous tis- 
>ue. In the early cases it can be controlled by 
irrigation per rectum, combined with pi"oper diet 
and rest. 

There remains an intermediate class of cases 
in wiiich ordinary treatment is unavailing, where 
there is an increasing mimber of stools daily and, 
although considerable strength remains, the pa- 
tient is weakening. These cases grow worse, and 
death is usually the result. This is the only case, 
in my judgment, in which the operation of cecos- 
tomy is justifiable. 

The results at the Colon Hospital were very 
favorable. Dr. Curl reporting eight cases of par- 
tial or total recovery out of 11. He also reports 
three cases of relapse which cleared up under 



irrigation. In one case, in which there was clinic- 
all)' a complete cure, an opportunity was afforded 
for an autopsy by the death of the patient from 
beri-beri three months later. The gut was found 
in excellent condition, the sinus being closed, and 
there was a broad, firm attachment of the cecum 
to the abdominal wall. 

The following case was operated upon by Prof. 
Samuel G. Gant, M.D., LL.D., of New York, at 
the U'niversity Hospital on April 27, 1910, for 
amebic dysentery : 

Name, W. R. ; white ; man entered hospital on 
March 31, 1910; age, 25 years ; occupation, British 
seaman ; family and past history of no importance ; 
complaint, dysentery. 

Present Illness. — About five years ago, while in 
Chili, he developed dysentery. This attack laid 
him up for about a week, and during his illness 
he took chloranodyne. He had si.x or seven move- 
ments a day. Feeling better, he went on duty, and 
enjoyed good health until he reached Dunkirk, 
I<" ranee. After being on shore for some time his 
dysentery returned. A chemist gave him some- 
thing, after which his movements were irregular, 
being about one or two in a week. 

Eight months previous to entering the hospital, 
while on the Black Sea, his movements became 
more frequent, amounting to si.x or seven per day, 
with the passage of blood. These movements 
were irregular, and would ease up for a day or 
two and then return. During movement he had 
straining and pain in the rectum. He was also 
unable to sleep. After reaching Rotterdam he 
stopped working, and was laid up for about 12 
days, during which time he had from 15 to 20 
movements per day, composed of water and blood, 
accompanied by much straining and pain. From 
here he went to England, and upon seeing a doctor 
was advised to go to an infirmary, where he was 
given some medicine which put him in better 



I02 



THE HOSPITAL BULLETIN 



health than he had been for five years. He tlieu 
set sail for the Canar_\' Islands, and from there 
went to Spain, where he was taken sick acjain. 
His movements were from 20 to 30 a day, passin^f 
slime, blood and water, with pains in the stomach 
and great weakness. Then he came to Baltimore, 

and was brought for treatment to Dr. F , and 

was advised to come to the University Hospital. 

The medicine given to the patient by Dr. F 

improved him, but shortly after entering the hos- 
pital he became worse, his bowels moving 13 or 
14 times per day, with blood. During this time 
he lost about 20 pounds in weight. He has suf- 
fered from veneral disease, but not syphilis. 

P/iysical Examination at Time of Entrance. — 
At time of examination patient is in dorsal de- 
cubitus, showing no evidence of pain. Head cov- 
ered with a good crop of black hair. Forehead 
negative. Eyes, pupils react to light and accom- 
modation. Left pupil slightly larger than right. 
Ocular motion good. Conjunctiva pale. Sclera 
clear. Nose and ears negative as to discharge. 
No tophi nor mastoid tenderness. Mouth, tongue 
protrudes in median line ; no coating, but of flabby 
character; teeth in poor state of preservation. 
Pyorrhea alveolaris marked. Pharynx shows 
some congestion. Neck rather long ; no abnormal 
pulsations ; no tracheal tug ; no glandular enlarge- 
ment. Chest slightly emphysematous ; expansion 
good and equal on both sides. Percussion reveals 
hyperresonance over entire front. Palpation neg- 
ative. Auscultation reveals the breath sounds 
somewhat roughened, inspiration slightly pro- 
longed over entire front. No rales. Back nega- 
tive, except slight hyperresonance and an occa- 
sional mucus rale in left apex and base. Heart, 
A. C. D. decreased to the right of the left nipple. 
Begins at tiiird rib and extends to the fourth rib. 
P. M. I. visible and ]:)a]pahle in the fourth inter- 
S])acc one inch to the left of sternal line. Sounds 
at apex rather snapping in character, but regular. 
Second ]-)ulmonic and aortic snapping; no nnir- 
murs or thrills. 

Abdomen. — Costal angle narrow: liver dullness 
begins at fifth interspace, and e.xtends to one 
finger's breadth below the costal margin. Ab- 
doiuinal walls relaxed ; no areas of tenderness 
noted ; no pal])able masses. Genitalia, no dis- 
charge, occasional palpable gland : scar in left 
groin resulting from bubo. Extremities, reflexes 
normal ; slight edema of anterior tibial region. 
Scabs noted on right tibia result of trauma. Up- 



per extremities, no glandular enlargement; no 
arteriosclerosis; pulse 1 10; volume and tension 
minus ; rhythm good ; no dicrotisni. 

Proctoscopic E.vaniination, b\' Dr. I. D. Rccder. 
Examination with six-inch tube reveals mucus 
and blood in large quantities. Entire rectum in- 
jected and edematous. Microscopic examination 
of mucus shows amebi coli in great numbers. 
Scrapings from ulceration shows the following : 
Blood corpuscles, phagocytical ameb?e histolytica, 
trachanonis intestinalis. LTine, light amber ; 
acid reaction ; Sp. Gr. 1035 ; albumen and sugar 
negative ; indican large amount. Microscopically, 
epithelial cells : large number of leucocytes ; no 
casts. Leucocyte count. 1S.400; red cells, 3,900,- 
000; Hgb., 60 per cent. Differential count, poly- 
morphonuclear neutrophilees, y^i per cent.; small 
mononuclears, 414 per cent. ; large mononuclears, 
9 '/J per cent. : eosino]Dhiles, ii'/i per cent. ; transi- 
tional, i^ per cent. Stool positive to ameba coli. 

Treatment. — Tinct. ferri chloridi gtts. X. t. i. d. 
Rectal irrigations twice daily of warm water, 
fluid extract krameria oz. 2 ; salol grs. 5 every 
three hours. This treatment was continued until 
time of operation. After the operation he was 
irrigated twice daily with potassium permanga- 
nate 1-10,000 and then 1-5000. He recovered 
after some difficulty. The sinus closed, and pa- 
tient left hospital cured. 

Operation — Cecostomy. 

Operator — Prof. S. G. (!ant. 

Assistant — Dr. Fred Rankin. 

Anesthetist — Dr. R. P. Bay. 

Anesthetic — Ether, by the drop method. 

Patient was taken to the operating-room and 
prepared for an aseptic operation. Through a 
two-inch intermuscular incision made directly 
(wer the cecum, it and the lov\'ermost part of the 
ileum are withdrawn and the edges of the wound 
covered with gauze. The anterior surface of the 
cecum is scarified after the ascending colon and 
ileum have been clamped to prevent soiling of 
t!ie wound when the bowel is opened. Four linen 
seromuscular ])ursestring sutures are introduced 
into the anterior wall of the cecum opposite the 
ileocecal valve; the bowel is opened inside the 
sliture line. The gut is grasped at the junction 
of the large and small intestine, and held in such 
a way that the ileocecal valve rests between the 
thumb and finger of the left hand. A Gant cath- 
eter is then passed directly across the cecum and 
through the ileocecal valve into the tmall intes- 



/ 



THE HOSPITAL BULLETIN 



103 



tine, aided by the thumb and fingers. The obtu- 
rator is removed from tlic g'uicle. and a catheter 
is iniroduced in the smaU liowel and held there 
by an assistant until anchored to the cecum by 
catfjut sutures to prevent slipping out during 
operation. A sliort rubber tube three inches loni? 
is projected into the cecum for an inch or more 
and anchored beside the one projecting into the 
small gut. The enfolding pursestring sutures are 
now tied, forming a cone-shaped valve about the 
catheters to prevent leakage of gases and feces. 
.Vfter removal of the clamp the cecum is scarified 
and anchored to the transversalis fascia, denuded 
of its peritoneum, by through and through linen 
suspension sutures. The suspension sutures are 
tied across rubber tubing and wound closed by 
the layer method. Catheters are fastened by 
stitching or by encircling them with an adhesive 
strip to lu)Id them together, and crossing this at 
a right angle a second piece of plaster, placed be- 
tween the pipes to prevent their slipping out. 
The ends of the catheters are closed with cravat 
clanijjs to prevent leakage, and the operation is 
completed by applying the dressings about tliL- 
projecting tubes. One tube is left longer than 
the other, or is identified in some way in order 
that the interne or nurse may know which is in 
the large and which in the small intestine wlien 
the time for irrigation arrives. To avoid danger 
of infection, treatment is not begun before the 
fifth day, except when urgent. 

The operation for appendicostomy is as follows : 
The appendix is approached through a gridiron 
incision, and located by tracing the anterior longi- 
tudinal bands downward, when it and the cecum 
are freed, brought outside and the wound pro- 
tected with gauze. The cecum is drawn first to 
one side and then to the other by an assistant, 
while the parietal peritoneum is removed at the 
sides of the incision to insure union between the 
gut and the transversalis fascia. The appendix 
is freed and straightened by ligating and dividing 
adhesions and the mesentery at a safe distance 
from it. I'ut when the appendix is free the mes- 
entery is not disturbed. After the cecum has been 
scarified two seromuscular suspension sutures are 
introduced into it at the sides and near the base 
of the appendix, each taking three bites in the gut. 
By means of a long-handled needle the anchoring 
stitches are carried through the abtlominal wall 
and clani])ed with forceps for identification. Hav- 
ing surrounded the appendix with gauze, a trac- 



tion suture is introduced to steady it while it is 
being amputated and cauterized. A Gant probe- 
l)ointed appendicular irrigator, closed with a stop- 
per, is introduced, and the appendix is ligated 
around it above the projecting rim. The a]:)pen- 
dix is placed at the lower end of the wound, point- 
ing upward and anchored by two gut sutures, 
w hich pass through the transversalis fascia. The 
alidominal layers are then approximated sep- 
arately, after which the cecal suspensory sutures 
are tied across rubber tubes. The irrigator is 
prevented from slipping out by the adjustment of 
adhesive straps, or by means of attached pieces 
of tape which encirle the body. In urgent cases, 
from one to three pints of warm saline solution 
are immediately injected into the colon when 
the irrigator stopper is introduced to prevent 
leakage. The wound is sealed by means of cotton 
and collodion, and is protected further by rubber- 
covered split gauze pads, which overlap each other 
when placed alx)ut the appendix. The end of the 
irrigator is surrounded by twisted gauze strips to 
prevent pressure upon it when the outer dressings 
are applied. 

The advantages of the former operation, 
namely, the Gant's cecostomy, which provides a 
means of irrigating both the large and small in- 
testine, are as follows : 

1. Owing to the fact that the cecum lies 
against the inner abdominal parietes, it can be 
easily anchored without angulation or twisting 
the bowel. 

2. Since the opening is opposite the ileocecal 
valve, a catheter can be introduced into the small 
bowel for irrigating or siphoning oi¥ its contents 
for examination. 

2- The cecal opening can be made of a suit- 
able size. The circular valvelike projection 
formed around the catheter by the unfolding 
pursestring suture prevents leakage. 

4. The catheter can be changed without diffi- 
culty. 

5. Closure of the opening follows withdrawal 
of the catheter and a few applications of the cop- 
per stick or cautery. 

6. Owing to the natural position of the cecum, 
there is less tension and pain following its anchor- 
age to the abdomen than occurs after appendi- 
costomy. 

7. Cecostomy (Gant's) may be employed in 
the treatment of lesions located anvvvhere in the 



104 



THE HOSPITAL BULLETIN 



intestinal canal, while appendicostoniy is limited 
to those of the colon. 

Disadvantages of appendicostomy : 

1. The appendix is more difficult to bring up 
for anchorage than the cecum, because of its 
deeper and more uncertain position, and because 
it is frequently bound down by adhesions or short 
m.esentery. 

2. Anchoring of the appendix causes angula- 
tion or twisting of the cecum, which, in turn, may 
induce constipation, discomfort or pain. 

3. When the cecum about the appendiceal base 
is caught in the wound it induces nausea. 

4. When the appendix is small, short, strictured, 
bound down by adhesions or is otherwise dis- 
eased, it is useless for irrigating purposes. 

5. Irrigation is frequently difficult and unsat- 
isfactory because of the small appendiceal outlet. 

6. Pain following appendicostomy is much 
greater than after cccostomy, owing to the pulling 
upon the appendix by the loaded cecum, the peri- 
appendiceal adhesions or squeezing of the at- 
tached mesentery when the wound is closed tightly 
about it. 

7. Frequent dilatation or insertion of a cath- 
eter is often necessary to keep the opening suffi- 
ciently large. 

8. Death has followed injection of irrigating 
tluid into the abdomen beside the appendix where 
an interne mistook an opening in the wound for 
that of the appendix. 

9. After cure it is more difficult to close the 
appendical than the cecal outlet, and an appendec- 
tomy may be necessary. 

10. Appendicostomy frequently fails, because 
the appendix slips back into the abdomen or re- 
tracts sufficiently to make irrigation almost or 
quite impossible. 

11. The appendix has been known to slough 
off several times owing to tension, its constriction 
by the sutures or destruction of its Ijlood su])])ly, 
making cccostomy imperative. 

12. Appendicostomy is not effective wiien the 
disease is located in the small intestine. 

13. Ap])endicitis requiring ajipendectoni)- fol- 
lowing closure of the a])pendiceal outlet has 
occurred. 

14. Owing to the irritation caused by the c;ith- 
eter or treatment, the mucosa may become so in- 
flamed and swollen, ulcerated or strictured, that 
irrigation must be abandoned. 



15. y\ccor<ling to Reed, the catheter causes the 
wall of the appcndi.x frequently to perish. 

16. Finally, the ajipendix may become blocked 
l)y angulation. 

Siiiniiiary. — In intermediate cases in which 
tiiere is still a reasonable amount of strength, but 
where treatment is not controlling dysentery, the 
operation of cccostomy with irrigation of the in- 
testine with quinine solution is indicated. 

Cccostomy is preferred to appendicostomy be- 
cause of less sloughing and easier closure of the 
fistula. The a]i]5endix should be removed at the 
time of fastening the cecum to the abdominal 
wall. 

A rapid improvement usually follows the begin- 
ning of irrigation, but convalescence is slow, and 
at times difficult}' is exjjerienced in closing the 
fistula. 

The after-treatment is tedious, and the patients 
are offensive cases to have in wards. 

All in all, it is the lesser of the two evils, but 
in my opinion it saves lives in selected cases. 



SPINA IIIFIDA— ITS PATHOLOGY, DIAG- 
NOSIS AND TREATMENT. 



P.y P.. S. lioVKK, '11. 
Sciiinr Mcdica! Student, Uiik'crsitv of Maryland. 



•Spina bifida occurs once in about 1000 births: 
oftener in females than in males. It is a congenital 
hernia of the spinal membranes, sometimes of the 
cord, through a cleft due to the absence of some of 
the vertebral arches. Etiology is unknown, but the 
best explanation is that of an imperfect separation 
of skin and medulla in embryonic life. (Ranke.) 

Patholoi^w — The defect may be confined to one 
arch, or may involve many ; rarely all. The 
fusion of the laminae commences in the upper dor- 
sal region, extending in both directions; its fail- 
ure to close causes a median posterior defect, 
which is most common in the lower part of the 
spine, where the sacral laminae are the last to 
solidify. This accounts for the frequency of this 
condition here rather than in other regions of the 
s|)ine. b'rom this defect in the skin and the low 
resistance it serves as a starting jjoint of inflamma- 
tion, and by extension a fatal meningitis is caused. 
There is also a lack of development or secondary 
destruction of the cord, causing paralysis of the 
lower limbs, sphincters, bowel and bladder dis- 
turbance and associated clefts. Thereft)re, such 



THE HOSPITAL BULLETIN 



105 



infants arc rarely, if over, viable, anil many are 
"still born" 

J'drictirs. — Ibe nunienclaturc of spina bifida is 
divided into three main varieties: 

(I) Spinal menintjocele, where the sjiinal mem- 
branes alone protrude in the sack. 

(II) Myelomeningocele; the cord and mem- 
branes both protrude, fluid collects, distends and 
forms a globular cavity of large size ; sack has 
wide base, flat contour ; contains nerve roots ; 
flattened cord or cauda etpiina in the sack. 

(III) Myelocystocele; the fluid is in the central 
canal, and the inner lining of the sack is formed 
bv the meninges and thinned-out spinal cord. 
Fluid collects in the central canal and distends it ; 
skin and sack closely adhere, and atrophy results 
from the effect of pressure ; circumscribed loss 
of epidermis is apt to occur, and may perforate 
the sack. This variety is often combined with 
deformities of the body, spine and feet. In all 
three the fluid is cerobro-spinal. and, as a rule, 
there is a cleft in the bony canal and dura. 

Syin/^tdins. — .\part from the presence of a 
tumor, many cases give no symptoms, although 
we have more or less paralysis of the rectum and 
bladder: sensory disturbance of lower extremities, 
may have abnormal conditions, as hydrocephalus, 
clubfoot or defects elsewhere. Frequently the 
bony cleft cannot be felt, due to size or tensio.i 
of the tumor, but in such cases the X-ray will 
reveal its absence. 

Diag^nosis. — The congenital origin, position of 
tumor filled with fluid where tension varies with 
posture and ex])iratory efforts, render the diag- 
nosis easy. The differential diagnosis of these 
tumors is more difficult, and at the same time is of 
greater importance from a prognostic and treat- 
ment standpoint, but until an incision is made it is 
often impossible to make an accurate diagnosis 
with certain evidence and firm foundation. In 
myelocystocele, by pressure on the tumor, we get 
a more decided and prompt swelling of the fon- 
tanels ; cleft is small, narrow, involving one to 
three vertebne; sensory disturbance in the Io\\er 
e.xtreuMties is more common : skin shows ulcera- 
tions or thin scars ; paraplegia, paralysis of sphinc- 
ters and other deformities are more often present. 
In nieningncele the tumor is almost always over 
the sacrum, has a small pe<licle and bony cleft, and 
absence of all symptoms except the local. Open- 
ing the sack we find the presence of nerve trunks. 
Myelomeningocele has a broad base, irregular and 



thin ulcerated covering, and a shadow may elicit 
the ])resence of nerves and cord in the sack. 

Proi^iiosis. — In general, all cases are unfavor- 
able. I'ortunately, most cases die early within the 
tirst few weeks. If not operated upon, few live 
to be over five years of age, the mortality averag- 
ing about 94 jier cent, in the first year. L'sually 
the tumor increases in size, the skin ulcerates, the 
sack perforating, and infection of the meninges 
terminates in death. If the patients survive the 
first few weeks, by paralysis of the bowels and 
bladder there is a constant danger of urinary 
sepsis, threatening life. Most cases living five 
years or more are meningocele, which is the most 
favorable variety, myelocystocele being next. 

Treatment. — Many cases demand only pallia- 
tive treatment ; the condition is incompatible with 
life, and unless relieved death occurs within the 
first few weeks. Pressure to prevent increase in 
size should be instituted with caution, if at all, 
an.d only when the skin is normal, owing to the 
liability of ulceration. Keep the surfaces clean, 
dry, and protect with cotton and sterile vaseline. 
If suitable for radical operation later on, aspira- 
tion may lie instituted to prevent rupture and 
diminish the pressure. The needle should be in- 
serted close to the base, where the skin is healthy 
and thick, and directed obliquely to avoid the in- 
juring of nerves. Aspiration alone is useless, and 
later proves fatal. Efiicient results have been re- 
])orted by Morton in those cases where operation 
is contraindicated in which, by aspirating one to 
two drachms of fluid and then injecting one-half 
to one drachm of fluid in, composed of iodin grs. 
X, iodid of potass, grs. XXX, glycerine ounces I, 
a repetition of the injection being required every 
10 days for two or three doses. Among the 71 
cases in the London Clinical Society, a mortality 
of 38 per cent, was reported, while Morton's own 
statistics showed a mortality of 15.3 per cent. 
Cure results from adhesions of the sack wall due 
tc the inflammatory reaction. In the hands of 
the other clinicians it has been found somewhat 
inefficient, and should only be resorted to in such 
cases where operation is inadvisable. 

At present operations are almost exclusively 
used. Opinions dift'er as to age. contraindications 
and operability of various forms. 

Hydrocephalus, marked paralysis, loss of 
sphincter control and deformities, as talipes, etc., 
are considered by most surgeons as contraindica- 
tions to operation. But it nuist be considered that 



io6 



THE HOSPITAL BULLETIN 



ail iiiifaviiral)lc result from the uperation is no 
worse than is to be expected without operation, and 
ii' by operating; it is possible to cure, or even im- 
prove, the condition, it is regarded by others a.? 
justifiable, as without operation they succumb to 
secondary infection, or, if they live, their condi- 
tion is such that life is a continual burden to them 
Ihroughout. 

.ii^c. — Autliors differ here from operating as 
early as possible to after five years. Operations 
on children under five years have an enormous 
mortality (35 per cent.), but after five years oper- 
ations are comparatively safe (4.7 per cent. ). If 
we wish to reduce the mortality and improve the 
symptoms, we must operate within the first year. 
Lovett ( 1907) reported a case of successful oper- 
ation immediately after birth, .^fter the fifth 
}'ear there is no hope of improving the paralysis, 
so that late operations have no efl^ect outside of 
removing the local tumor. If tumor is not rapidly 
enlarging, and is covered with sound, thick skin, 
it is not advisable to operate- 

Operation. — Chloroform is the best anesthetic. 
The hips should be slightly elevated and body 
kept warm by hot blankets or water bags. Care- 
fully clean the skin, and, if ulcerated, sterilize by 
carbolic and follow by alcohol. The incision 
should be made at the side, and after entering the 
sack replace the nerves in the vertebral groove and 
dissect away the redundant and ulcerated tisstte. 
Special devices for closing the bony defects to 
prevent recurrence is unnecessary, as, unless we 
have complicating it hydrocephalus or infection, 
there is little or no tendency to recur. If hydro- 
cephalus, the operation is contraindicated, and one 
should, at the present date, avoid infection. 
Merely covering the cleft with lateral flaps of 
muscle and facia and suturing is sufficient. Thi; 
(luickness of operating and best techni(|ue in these 
cases gives the most favorable re-sults, as patients 
cannot stand long o])erations, and it lessens the 
danger of infection. h'inall}, suture the skin, 
which should lie done to one side, and not directly 
over the sack; drainage is not necessary if aseptic 
precautions have been followed, and unwise, as 
ii favors infection. The wound should be dressed 
with the greatest care to prevent soiling and in- 
fection. Collodion or rubber tissue should be used, 
combined with fre(|uent changing of outside dress- 
ings and najjkins. 

Results. — If all cases are followed up and re- 
]-orted. the total mortality, ;! few weeks after 



operation, would aggregate fully 50 ])er cent., the 
cause of death being shock, meningitis, hydro- 
cephalus and septic infection, ^^'ith the report 
of a high mortality and the statistics to show some 
complete cures, it should not deter us from at- 
tempting surgical relief. 

REJ^ERK.NCK.S. 

Muniford's Practice of SiirL:^ery. 
Keeiic's System of Surgery. 
American Textbook of Sur^^ery. 
Taylor's Orthopedic Surgery. 
Daeosta's Surgery. 
Butler's Physical Diagnosis. 



AUTOENUCLEATION OF hlBROMA 
COMI'LICATIXG PREGNANCY. 



By J. A. Devlix, M.D., 1906, 
Gynecologist to the A'orthern Dispensary : Sur- 
geon to Hudson Street Hospital, O. P. D. 



The comparative rarity of the case T will de- 
scribe leads me to believe that a report on it will 
be of interest to Tije Bui.t.etin readers. 

In November, i<;io, I was asked to see a primi- 
para, 35 years old, who was supposed to be in her 
eighth month of pregnancy. 

Five days before I began to attend her she had 
a sharp liemorrhage, which her physician man- 
aged to control with difficulty, and fearing that 
she liad a placenta ])revia, advised her to go to 
some hospital. This advice was not followed out, 
and as the physician tlicn refused to have any- 
thing further to do with the case I was asked to 
give my opinion. 

Examination and personal history revealed to 
me that I had a dead fetus to deal with in a 
uterus which had a firm mass about the size of a 
large cocoanut in the anterior and middle portion 
of the body of the uterus. 

On explaining the nature of the complication, 
the woman was easily prevailed upon to enter the 
hospital, and the same evening I introduced a 
uterine bougie well into the cavity of the uterus 
and packed the vagina tightly with sterile gauze. 
The following morning the gauze was removed 
and a cleansing iodine douche was given, the 
bougie remaining in place. 

At 5 o'clock that afternoon she had active labor 
pains and a six-months' macerated fetus was de- 



THE HOSPITAL BULLETIN 



107 



livcrcd. Its skull slu)\v(.-(l marked evidence of 
l)ressiire from the tumor. 

As all pains ceased after delivery of the fetus, 
and owing to the position of the now definite 
fibroma, which precluded the Crede method of 
placental expression, I inserted my hand into the 
cavity of the uterus to remove the placenta and 
examine nmre tlioroughl\- the tumor, which I 
found to he suljniucous. 

The j)atient was then returned to bed in good 
Condition, as there was praclicall\ no hemorrhage, 
and a waiting jKilicy adojjted. l-"or 24 hours after 
the ])atient had normal pulse and temperature and 
sanguinous discharge. ( )n the second day, how- 
ever, her temperature rose to ioi°, and the dis- 
charge became more profuse and foul in odor. 

.As 1 was ])erfectly confident that there were n</i 
retained secundines, I attributed the rise in tem- 
l)erature and profuse discharge to beginning dis- 
integration of the tumor mass, which by the rapid 
contracture of the uterine musculature was de- 
])rived of its blood supply. I'requent vaginal 
douches were given to ensure cleanliness, and on 
the fifth day I removed from the cavity of th.e 
uterus several large pieces of the sloughing tumor 
which were forcing themselves through the cer- 
vix. This removal of loose pieces of tissue was 
done every day for five days. On the fifth and 
last day I removed two pieces, each about the size 
of a large orange. An intrauterine douche was 
given, and on sweeping my finger over the uterine 
cavity I could find no more evidences of the 
fibroid, which had sloughed out. but there was a 
small one in the posterior wall intact, about the 
size of an English walnut. This one I left alone, 
not considering it wise at tliis time to attempt 
enucleation. 

The following morning the [)atient's tempera- 
ture was normal and remained so thereafter, the 
horrible discharge entirely absent, which was a 
profound relief to the patient and her attendants, 
I assure you. 

Subsequent examination in my office showed 
the uterus slightly retroverted but perfectly mov- 
able. A small, hard nodule could be felt in the 
posterior wall just above the cul-de-sac. The 
adnexa were normal. 

In conclusion, I might say that if this, woman 
becomes pregnant again she will more than likelv 
iiave difficulty, as I am sure there are more small 
fibroids in the body of her uterus only waiting for 
an increase in nourishment to increase in size. 



.\ I'.ACTERIAL ROT OF ONIONS CAUSED 
V.Y BACILLUS COLL 



l!y A. W. (iiAMi'iETUo, M.])., KJ07. 
Lulwratory of Plant Pathology, U. S. Departtiicnt 
of Agriculture ; Uiiizrrsify of Marylaiiil. 
1907. 



In August, 1910, specimens of onions were re- 
ceived by the writer from Mr. Uenj. Hartzell of 
Shepherdstown, W. Va., affected with a soft, 
granular, greasy, dark-greenish rot, emanating 
an offensive odor. In cutting through the speci- 
mens it was noticed that sometimes one scale was 
totally rotten from top to bottom and entirely 
around the bulb, while the adjoining scales on 
either side remained sound. Cases were also 
found in which two or more scales were affected, 
while intervening or adjoining ones were healthy, 
(ienerally the rot extended from the upper part 
downward toward the root end, although in 
some cases the whole bulb was involved, being 
particularly soft at the lower end. 

.Several sets of plates were poured from this 
material and out of numerous colonies, which ap- 
peared after an incubation period of 12 to 18 
hours at room temperature, pure cultures of five 
distinct colonies were transferred to beef bouil- 
lon, from which another set of plates was poured, 
in order to ascertain the purity of each colony, 
and final transfers were made on beef agar. The 
five cultures were marked Nos. i, 2, 3, 4 and 5, 
respectively. 

Using very sound onions, obtained in the open 
market, inoculations were made under the most 
antiseptic conditions. Some specimens were in- 
oculated by puncturing in two or three places on 
the same scale with a platinum needle infected 
with a 24-hour-old culture of the organism ; some 
were punctured on several scales, leaving several 
uninoculated scales between them, and still other 
onions were inoculated by having the infected 
l)latinum needle smeared over all the cut surface. 
The sets of inoculations, consisting each of six 
inoculated onions and two controls, corresponded 
to the number of pure cultures to be tested. 

The inoculated specimens were kept under 
bell-jars at room temperature, and every other 
day a few drops of sterile distilled water were 
poured on each onion from a sterile pipette. 

The onions inoculatd with cultures Nos. 2, 4 
and 5 began to rot after one week, and in each. 



ro8 



THE HOSPITAL BULLETIN 



case about three-quarters of the huUi was r<Hten 
at the end of the fourth week. 

Cultures Nos. i and 2 showed negative results, 
and were, therefore, discarded. 

Four sets of plates were poured from the i)osi- 
tive inoculations and two pure cultures isolated 
from each of the colonies appearing in each set 
of plates. These pure cultures were further tried 
on sound onions, and produced the same rot 
which affected the onions originally received 
from West Virginia. They were, therefore, re- 
tained as the exciting cause of the disease. 

Reviewing the available literature on this dis- 
ease, it will be found that F. C. Stewart of the 
New York Experiment Station first described the 
malady in 1899, and his reference to the organism 
supposed to be the cause of the disease is sum- 
marized as follows : 

"Microscopic examination of the rotten tissue 
shows entire absence of fungi, but there are 
swarms of a medium-sized motile l^acillus, which 
is without doubt the immcfliate cause of the rot." 

Sorauer, discussing the bacterial diseases of 
the onion, attributes this rot to a motile bacillus, 
but. in view of its polymorphous aspect at differ- 
ent times, he concludes that the trouble is i)rob- 
ably due to a complication of diseases. Quoting 
his words : 

"From this fact it appears with certainty that 
we are not concerned here with one disease, but 
with a rot disease in which several species of bac- 
teria take part." 

His failure to reproduce the disease on sound 
onions kept in inoculated water cultures led him 
to conclude that the disease is due to a sapro- 
phytic micro-organism present in the soil, which 
becomes parasitic on wounded onions. In this 
connection he says : 

"Possibly we are concerned here with a dis- 
ease in which harmless soil bacteria become para- 
sitic after a previous wounding of the onions and 
a subsequent excess moisture of the soil." 

The late Dr. George Delacroix in 1906 pub- 
lished a paper entitled "Sur la maladie appalee 
Grass de I'Oignon," in which, after describing 
the flisease, he asserts that it is caused by a bacil- 
lus — a non-molilc gas producer, which is decol- 
orized In' Gram's stain, and which he named 
Bacillus ccf<i-i'onis, n. sp., George Delacroix, 
'i'liis Ijacillus, according to Delacroix, does not 
re(|uire a wound to produce infection. He says: 

"Infection is produced easily by means of rot- 
ten jjuljj or cultures, and on young .scales ])lace(l 



in a moist place penetration (by the organism) is 
accomplished without wound." 

That all three investigators refer to the same 
disease is evident from the fact that the descrip- 
tion first given by Stewart has been followed bv 
Sorauer and Delacroix. Sorauer refers to Stew- 
art's published description of the malady, and 
Delacroix acknowledges and cites the ])ublica- 
tions of both Stewart and Sorauer. 

In view of these meager and contradictory 
statements, a special laboratorv investigation of 
the disease was begun, with the hope of definitely 
determining the causative organism. 

A study of the morphological and the physio- 
logical characters of the organism confirmed the 
findings of Stewart and Sorauer as to its motility. 
It was further ascertained that it did not stain 
by Gram's metliod, produced gas and indol on 
standard media, and ]5resented other characteris- 
tics pointing to its unmistakable relationship with 
B. coli. To definitely establish this relationshi]) 
and ]JossibIe identity, a pure culture of B. coli 
was obtained from ^Ir. J. H. Johnston, formerly 
an assistant ])athologist in the United States De- 
]«rtment of Agriculture. This pure culture was 
a transfer made by Prof. Theobald Smith from 
his stock culture No. 15. 

A comparative study of the onion rot organism 
and B. coli, both on artificial media and by inocu- 
lations on sound onions, was then begun. Nu- 
merous parallel experiments with the two organ- 
isms, producing identical results, have convinced 
the writer that Bacillus ccpivonis is the same as 
B. coli. ISoth organisms are polymorphous, and 
are motile, having peripheral flagella ; both are 
decolorized by Gram's stain, produce gas on suit- 
able media, produce indol, reduce nitrates, coag- 
ulate milk slowly, and grow best on alkaline 
media. Neither liquefies gelatin. The optimum 
temperature for each is 37 degrees C, and their 
thermal death point 4-5 minutes at 60 degrees C. 
Each produces rot on sound onions, and can be 
recovered in pure cultures from the diseased host 
(onions). 

In addition to the laboratory tests, inoculations 
were made on healthy onions growing in pots 
and in water cultures, and also on cocoanut palms 
in the greenhouse, with results proving the find- 
ings of Sorauer, that the occurrence of the dis- 
ea.se is secondary to the infliction of a wound. 
I'hvsio-biochemical studies of these bacilli on 
artificial media were also conducted. These latter 
tests revealed tlie identity of B. coli and B. ccj'i- 



THE HOSPITAL BULLETIN 



109 



I'onis by |)oiiiting to the identical production of 
cellular activities of both t)ri;anisnis, as shown in 
their jirodncts of fermentation ( sjas, ethylic alco- 
hol and lactic acid), indol, reduction of nitrates, 
and non-li(iuefaction of .t;clatin. 

A s|5ecial biochemical stu(l\- of both organisms 
in connection with the ])roduction of g;as and 
intiol and in relation to the li(|uefaction of gelatin 
is being continued for further proof of their iden- 
tity, and detailed results will be ]5ublished as soon 
as the work is completed. 



•STRICTURE OF THE DEEP MALE URE- 
THRA OF SMALL CALIBER." 



Bv 



C. WiLKiNS, 'ir. Senior Medical Student. 



A stricture of small caliber in the deep urethra 
is a narrowing of the lumen of the urethra below 
the size of a No. 18 French sound, at or posterior 
to the bulbo-membranous junction. 

There are three varieties of stricture well recog- 
nized by the ]iistor\', symptoms and physical find- 
ings : 

I. Inflannnatory : 
H. Spasmodic, and 

HI. Organic. 

I. Inflammatory stricture is produced by soft, 
inflammatory cellular infiltration, which may be- 
come absorbed, or may go on to exfoliation of the 
mucous membrane and scar tissue formation, and 
form a true organic stricture. It is nothing more 
than an inflammatory, edematous and congestive 
swelling, enough to almost obstruct the passage 
of urine. 

II. Spasmodic stricture often contracts so 
small as to be classed as stricture of small caliber. 
It is not truly a stricture, but has to be dealt with 
and differentiated from organic stricture. It is 
(hie to the contraction of the periurethral bands of 
muscle or bands of connective tissue found as a 
result of some inflammatory process. This refle.x 
spasm arises from a urethritis, erosions of the ure- 
thra, hemorrhoids, prostatitis, and fistida, or an\- 
injury to the pelvic organs. .Spasmodic strictures 
relax by the administration of morphia and the 
passage of a sound against the stricture with 
gentle pressure. The treatment is to remove the 
exciting cause and ]5revent any complications from 
arising until the cause is relieved. 

HI. True or organic strictures are those due 



to a previous urethritis i!i the vast majority of 
cases, especially in those cases in which the ure- 
tin-al inflammation has reached an exceptionally 
high grade of intensity, or which have run a very 
jjrotracted course. However, quite a few result 
from trauma received from injuries to the peri- 
neum or lacerations of the mucous membrane by 
rough, unskillful instrumentation, whicli produces 
the well-known "false passage." The pathological 
condition varies from a simple induration and 
thickening of the mucous membrane with con- 
nective tissue, proliferation occurring in its 
depths, to the exfoliation of the mucous membrane 
and formation of a dense mass of cicatricial tissue 
occupying the submucous region and deeper struc- 
ture of the urethral wall, which contracts and pro- 
duces a permanent dense hard band or mass of 
scar tissue. In the traumatic variety the process 
is similar to the inflammatory variety in the end 
result. The laceration heals by round cell infiltra- 
tion and cicatrization. The mucous membrane 
])osterior to a small caliber stricture is always the 
site of a chronic catarrhal inflammation, which 
gives rise to a gleety discbarge. A chronic pros- 
tatitis is usually associated with those of long 
standing, especially the inflammatory variety. As 
a result of the use of non-sterile catheters and non- 
aseptic techniciue of catherization, a cystitis is 
almost sure to be set up. 

Stricture of small caliber so markedly interferes 
with the passage of the urine that there is pro- 
duced an atony of the bladder by retention, and 
atony of the bladder predisposes to cystitis, which 
has a tendency to extend to the ureter and finally 
to set up a pyelonephritis and uremia. 

Syinptoins and Diagnosis. — The symptoms de- 
pend to a great extent on the complications asso- 
ciated with this condition. In most cases a history 
of a chronic gonorrheal urethritis or trauma will 
be gotten. The insidious onset following a ureth- 
ritis is of importance. It often takes two years 
for an organic stricture to develop after the initial 
exciting cause. Frequency of urination at first is 
due to congestion and inflammation of the urethra 
jiosterior to the stricture or verumontonitis, pros- 
tatitis or cystitis ; later, frequency of urination 
may be due to atony producing retention and 
dribbling. Distortion of the stream is very char- 
acteristic, being very small, twisted or forked. It 
requires a longer time for the patient to void his 
urine, the force being so much lessened. A gleety 
discharge, composed of muco-pus and shreads in 



1 10 



THE HOSPITAL BULLETiX 



the urine, due to the ehronie catarrhal inflamma- 
lioii of tlie uretlira posterior to the stricture point. 

-Acute retention is a common occurrence follow- 
ing exposure to cold and wet. alcohol and sexual 
excesses, which produce either congestion of the 
stricture or a spasmodic contraction of the stric- 
ture entirely occluding the lumen of the urethra. 
J'ain along the urethra is \-arial)lc. Sexual func- 
tions are marlcedh interfered with. At times the 
.semen may ])e kept ])osterior to the stricture for 
some time. In addition to the above symptoms, 
the diagnosis is completed by scruljhing of the ex- 
ternal genitalia with soaj), water, and applying bi- 
chloride t)f mercury, alcohol and sterile water. 
Then irrigate the urethra with potassium perman- 
ganate 1-6000. followed by hot normal salt solu- 
tion. Select a metal sound or a flexible wa.x 
bougie a boule, Xo. 20, French, and pass it down 
to the stricture, where it will stop and refuse to 
iiass. l>y measurement of the instrument used and 
])alpating the end of the bougie through the peri- 
neum, one can estimate fairly accurately the loca- 
tion of the stricture, wiiich is surgically most im- 
portant. If the stricture is not complete it will be 
possible to pass a filiform, which in those cases 
complicated by acute retention insure no disas- 
trous results to follow, as the urine will trickle 
In- the side of the guide. 

Treatment. — The treatment of stricture of small 
caliber in the deep urethra as in the pendulous 
urethra is divided into (i) dilation and (2) some 
form of urethrotomy, either internal or external. 

Dilatation is the treatment of choice, j^rovided 
the .stricture is applicable to such a conservative 
means. When there is a stricture of short dura- 
tion, soft and dilatable, regardless of its location 
and size, it should not be cut, but dilated by sys- 
tematic ])assing of sounds. Inflammatory and 
s])asmodic strictures are es])ecially amenable to 
dilatation ; at the same time the cause should be 
vigorously treated. 

.\fter having taken the aseptic precautions as 
laid down above under diagnosis, try to pass a 
large .sound. No. 20, I'^rench, which will probably 
not pass. Then pass in small whalebone filiforms, 
one after the other, side by side, until one ])asses 
the stricture point. Tiien attach a follower to this 
about the size of a No. 8 French sound, and 
slowly dilate the stricture. After ])assing a No. 8 
and there is no marked bleeding, attach a No. 10 
or 12, which if passed will relieve the condition 
to a great extent, (jive the patient niori)hia, gr. 



,'4, and quinine, gr--. x. to ])revent the often met 
with urethral chill. 

The patient should go to bed for a day or two. 
depending on the amount of shock jjroduced. P)Ut 
as a rule he can be u]). if no exertion is iiululged 
in. Jlc should drink large (juantities of water, 
and on the second day receive the second instru- 
mentation, after aseptic precautions have been 
taken, when large souncU can be jjassed equally as 
easy as the first ones were. This should be kept 
u]) every other day. increasing the sounds each 
time until the normal size caliber of the urethra 
is reached, which will be at the end of two or three 
weeks. The symptoms will have cleared up. no 
doubt, and the patient think himself well, but it is 
of great importance for him to co-operate with the 
]ihysician in the after-treatment. 

After the first month sounds should be ])assed 
from No. 20 to 28, French, for about four months. 
Then once a month for si.x months, and about fotn- 
times each year of the ])atient's life. When dilata- 
tion cannot be done, internal or e.xternal ureth- 
rotomy should be resorted to. In tiiis class of 
strictures external m-ethrotomy is the operation 
of choice, but cannot be done in a certain class of 
cases, and, in fact, by some internal urethrotomy 
has been done with apparently no bad results. If 
the i^atient has some constitutional disease and can- 
not take a general anesthetic, or for any reason a 
general anesthetic is contraindicated, or if the 
jjatient is not able to withstand the shock of a 
])eriueal section, and especially if the confinement 
in bed following such an operation is unwise, one 
is justified in performing an internal urethrotomy 
on the deep urethra, regardless of the danger of 
hemorrhage and infiltration of urine in the sur- 
rounding jiarts. with all the various conqilications 
following. 

In addition to the general pre]:iaration of a p.a- 
tient for an operation, the urine shoidd be ren- 
dered non-irritating by the administration of saiol 
or urotropin gr. vii three times a day for at least 
three days. If highly acid, give ])otassium bicar- 
bonate to lessen acidity. Scrub up the external 
genitalia with soa]) and water, shave and follow 
with alcohol and bichloride of mercury. Irrigate 
the urethra well with 1-6000 j)otassium perman- 
ganate, followed by irrigation with sterile hot nor- 
mal salt solution. Then, if possible, fill the blad- 
der with sterile normal salt solution to render the 
urine less irritating, .-mil to wash the cut surface 
after the o]ieration. 



Till-: llUSi'JTAL BULLETIN 



I II 



Inject into tlu' urethra as an anestliotic a J per 
cent, solntion of cocaine. I'as.s in a filiform ami 
thread the < )tis nrelhrotome over it. ha\inf;- pnl 
the knife in the inslninient ])revions to this. '! hv 
stricture is dilated hy turnint;- the dial of the instru- 
ment to the desired size. Then the striclnre is 
cut by pullinn- the knife outwards. The knile i^ 
pushed back, dilatation is increased and die knife 
drawn outwards a!.;ain. to make sure the desired 
result has Ijeen acconijdished. it is well then lo 
])ass a Xo. jS l-rench sound, irrigate out the 
urethra with sterile hoi normal salt solution, 
which w-ill remove the clots and arrest liemor- 
rhajje to a f;reat extern. 

(live the patient at once (|ninine grs. x and mor- 
phia ,t;r. '4. ( )r(ler the paiient to stay in bed for 
four days, as a rule, and drink an abundance of 
water and eat a Iii;Iit liipiid diet. 

.\t the end of _>4 hours instrumentation should 
iiegin. and be ke])t u)) as described under the treat- 
ment of stricture in the deep urethra which is 
dilatable. 

I'^xternal urethrotomy should be emjdoyed — ist, 
on all uiidilatable strictures of the deep urethra: 
pro\-ided the paiient is stroui;- enough to withstar.d 
the shock of a general anesthetic and an opera- 
tion. 2d. .\11 traumatic strictures with infiltra- 
tion of surrounding tissues with urine in the deep 
urethra. 3d. Im])assal)le stricture complicated lj\ 
retention. 

h'xternal iu'ethrotom_\- with filiform guide, oxer 
wliich is threaded a sound or catheter down to the 
stricture point, is the oj^eration of choice. The 
operator by this means has no difficulty in finding 
the stricture by cutting down on the end of the 
souikI |)arallel with the urethra, and then remov- 
ing the souiul and retracting the tissues, the fili- 
form can be followed au<l the stricture incised 
without any ilifficulty. The e.xterna! vesicle 
sphincter is dilated and a retention catheter put 
into the bladder anil alkiwed to come out through 
the ])erineal wound. 

1 leniorrhage is controlled bv artery clamps and 
hot normal salt solution. One in the after-treat- 
ment should look out for secondary hemorrhage, 
and treat it vigorously if it occurs. The patient 
should be put in the senii-recnmbent position in 
bed and the bladder drain connected with a bott'e 
to prevent the soiling of the bed linen. Ciood blad- 
der drainage is of the greatest importance for the 
first four days, as it prevents the urine from com- 
ing in contact with the freshlv-made wound until 



septic absorption is guarded against by formation 
of granulation tissue. 

.Vfter the removal of the catheter. alHiiit ihe 
fourth or fifth <la\-. the gentle jjassage of souiuls 
through the entire urethra should be instituted. It 
is best to begin with as large a .sound as will pass 
without am great discomfort to the patient, and 
gradually increased until the normal caliber is 
reached and the i)eiineal drainage ceased with the 
complete healing of the wound. 

The urethra and jjerineal wound should be irri- 
gated before the sounds are jiassed with i-i')0OO 
potassium |)eniianganate, followed by sterile nor- 
mal salt solution. It is well as a routine to give 
the ])atient mori)hia gr. '4 and quinine grs. x after 
the operation to ])re\ent a urethral chill. Liro- 
mides mav be necessary to give the patient the 
proper amount of rest and sleep for the first few 
ila\'S, but should only be used in case of necessity. 
The ])atient will be able to be out of bed in the 
average numlier of cases in 10 days. To ]:)revent 
recontraction and |)ossibly a more extensive stric- 
ture, it is highl\- necessary to pass sound every 
otiier dav for a month, once a week for three 
months, then once a month for six or eight months, 
then four times a year for the rest of the ]iatient's 
life. 

In conclusion, 1 wish to say that some strictures 
are so limited in extent that they may be excised 
and the several ends of the urethra united with 
catgut sutures, and that when this can be tlonc 
it is an ideal method of treatment. 



R.ADICAL CT'RE OF PAIXFL'L HALLUX 
\"ALGU.S, WTTH REPORT OF CASE. . 



r>v N.vni.w W'lx.-Low. M.D., U)Oi 



While ni)^ experience with ])ainful hallu.x val- 
gus is limited to the one ease which I am about 
to report, the result obtained and the simplicity 
of the operative technic warrant its presentation 
to the readers of Tmc liuLi.K'iix. Hallux x'algus 
is that condition in which the a.xis of the great 
toe deviates outward from the norm in extreme 
cases as much as <p degrees. The big toe, in- 
stead of projecting forward from the foot on an 
axis extending through the center of the great 
toe and the mill point of the heel, projects (jut- 



ii: 



THE HOSPITAL BULLETIN 



ward across the toes. This condition arises from 
two factors at least — the wearing of too-short 
shoes and an aljnorinally long toe. the big toe 
extending from one-quarter to onerhalf an inch 
beyond the second toe, as a result of which cramp- 
ing the axis of the large toe is made to extend 
outward. As there is an associated bursitis over 
the inner side of the metatarsn-phalangeal joint, 
the condition is popularly designated bunion. 
Therefore, when used in this connection, bunion 
a-sunies a rather complicated as]5ect, for not only 
is there an inflammation of the bursa overlying 
the metatarso-phalangeal articulation, but also a 
partial dislocation of the toe, and in some in 
stances exostoses on the head of the metatarsal 
bone, and at times a periostitis. 

The wearing of shoes becomes unbearable, and 
walking with any degree of comfort is impos- 
sible. The pressure of shoes sets iip cramp-like 
pains, which, in some cases, persists even after 
their removal. The joint is red and swollen and 
tender to pressure. Xo minor afifection gives 
rise to greater inconvenience and discomfort to 
the patient, who is most frequently a woman. 

Occasionally relief may be obtained by the use 
of various appliances or pro])erly-shaped shoes, 
but most frequently relief can only be obtained by 
operation. 

Many operative procedures have been devised 
for this trouble, among which may be mentioned 
the resection of the head of the metatarsal bone, 
arthrectomy of the joint, osteotomy of the meta- 
tarsal bone imiuediateiy behind the head, and the 
Mayo operation, resection of the head of the first 
metatarsal bone, with a restoral of the joint b)' 
the covering of the raw surface of the resected 
bone with a flap of synovial membrane obtained 
from the bursa. This operation gives immediate 
relief, and leaves the patient with a good, movable 
joint. In my case the result obtained was perfect. 

RICl'ORT OK CASK. 

During the early i)art of March, 191 1, Miss W. 
of .\tlantic City. X. J., 38 years of age, consultei 
me ai)out an extremely painful Inuiion of the right 
great toe, com])licated by hallux valgus. The pain 
was so great that even after a very short walk she 
was comjjelled to remove her shoe. She had been 
suffering with the trouble for 15 years, and which, 
as time progressed, became gradually worse. The 
joint was red, swollen and jjainfid to pressure. 
Tiicre was marked thickening about the joint. 



Deformity was marked, and the head of the first 
metatarsal bone coukl easily be pal|iated beneath 
the skin. The a.xis of the great toe had become 
ileviated outward to about fio degrees. I advised 
Maxo's radical operation, to which she consented. 
Operation. — On Tuesday, March 14. the patient 
was anesthetized at the home of her father, in 
ISaltimore, by Dr. W. H. Smith. A semi-circular 
incision was then made, beginning on the inner 
side of the foot near the plantar aspect of the base 
of the proximal phalangeal bone, and directed up- 
ward and swept over the head of the metatarsal 
bone. The skin flap thus outlined was dissected 
free from the underlying tissues, with its pedicle 
directed downward. The next step consisted in 
reflecting from the outer side of the head of the 
first metatarsal bone a flaj) with its base attached 
to the ])ase of the proximal phalanx. This flap 
consisted mainly of fat, which was lined on its 
inner aspect by synovial membrane from the in- 
volved joint. The projcctingheadof the metatarsal 
bone was resected, and the fatty flap inserted 
between the raw surface of the resected bone 
and the base of the pro.ximal phalanx, where 
is was held in place by a few sutures, thus giving 
a joint whose surface was lined throughout with 
synovial membrane. The skin flap was finally 
sutured with interrupted sutures of catgut. 
Drainage was provided for by inserting a few 
strands of silkworm-gut at the lower end of the 
incision. This was removed in two days, and 
the wound healed by first intention. The patient 
was out of bed on the third day, and by the tenth 
was walking about the house. In less than a 
month's time after the operation she had walked 
at one stretch more than three miles without an\' 
return of pain or discomfort. 



The staff of the University 1 lospital for the 
ensuing year is as follows : 

Medical .Superintendent — W'm. J. Coleman, 
M.D. 

Assistant Resident Surgeons — Drs. Joseph ^^^ 
Hooi)er, Fred ^V. Rankin, Wni. A. Gracie, N. C 
Steward, C. N. Devilbiss, A. C. McCall. 

Assistant Resident Physicians — Drs. J.lM.Rlod- 
gett, G. C. Coulbourn, U. C. I^odson. 

Assistant Resident Gynecologist.s — Drs. H. P.. 
Gantl, T'itzR. W'inslow. 

Resident Pathologist— L. K. Walker, M.D. 



THE HOSPITAL BULLETIN 



113 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, August 15, 191 1. 



NEW REQUIREMENTS OF THE NEW- 
YORK IU)ART) OF REGENTS. 



The following- circular from the New York 
lioard of Regents and the reply from Dean R. 
Dor.^ev Coale are self-exi)lanatory. For some 
time the writer has insisted that the die was cast, 
and that medical schools would soon be required 
to have at least five full-time, salaried instructors 
in the laboratories and scientific branches. It was 
no: tliought. however, that this requirement would 
become effective for several years. W'e had not 
read the handwriting on the wall aright. We are 
now face to face with an imperative order to sup- 
jily six. not five, full-time, salaried instructors by 
October i, 1912. The command admits of no 
argument : we must comply or lose our New York 
registry. We cannot afford to do this, and the 
order must Ijc obeyed. Moreover, the various 
educational boards and associations are going to 
make the same ruling within two years. The gist 
of the matter is this : the medical school of the 
L'niversity of Maryland must get on an endowed 
basis or close its doors after a successful and hon- 
orable career of more than 100 years. Fellow- 
alumni, which do you prefer — to see your alma 
mater go out of existence, or to help us in the 
effort we are making to raise funds in order that 
she may survive? 

State of New York, 
Education Department, 

.-Vlbany, July 14, ii)i 1. 
To the Deans of Medical Schools : 

Allow me to call \our attention to the following 
resolution adopted by the ISoard of Regents at a 
regular meeting held June 27,. iqii: 



"Rcsolz'cd, That section 409 of chapter N of the 
Regents' Revised Rules be amended by adding 
thereto so that the first ])aragraph shall read as 
follows : 

"Section 409, Schools of Miidicim:. .V school 
of medicine may be registered as maintaining a 
proper medical standard and as legally incorpo- 
rated. It must have apparatus and equii)ment 
and resources of $50,000. It must by ( )ctoher I, 
i(;i2, have at least si.x full-time, salaried in- 
structors, giving their entire time to medical 
work : a graded course of four full years of college 
work in medicine, and must require for admission 
not less than the usual four years of academic or 
high-school preparation or its ecjuivalent in addi- 
tion to the preacademic or grammar-school 
studies." 

Handbook No. 9, which contains the law. rules 
and information upon medicine, and issued b\- this 
department as one of the series of handbooks upon 
higher education, will be revised June, i(;i2, and 
will contain under the registered medical schools 
in each State only those institutions that \\ill con- 
form to the requirements of the above resolution 
by October i, 19 12. 

I am calling your attention to tliis regulation of 
the Board of Regents thus early that your insti- 
tution may have its proper recognition in the 
handbook. 

Yours respectfully. 

Augustus S. Downing, 

First Assistant Commissioner of Education. 

L'niversit}' of Maryland, 
Faculty of Physic, 

Baltimore, July 23, i<)ii. 

Augustus S. Downing, LL.D.. 

First Assistant Commissioner of Education, 
Albany, N. Y. 

Dear Dr. Downing — I have the honor to ac- 
knowledge the receipt of your circular-letter of 
July 14, containing the resolution recently adopted 
by the Board of Regents regarding the regi.stra- 
tion of schools of medicine. 

As regards apparatus, equipment and resources, 
course of instruction ofTered and requirements for 
admission, this institution is, I believe, already 
very well up to the prescribed standard, and we 
hope, and confidentlv expect, that by the opening 
of the session of 1912-1913. the time stated in your 
letter, we will also be prepared to conform to the 



114 



THE HOSPITAL BULLETIN 



reciuiruiiicnts uf the TSoard of Regents in the mat- 
ter (if the six full-time, salaried instructors. 
With lie^t personal respects and regards. I am. 
\'ery truly yours, 

R. DORSEY COAI.K. 

Dean. 



lolX THE THROXC. 



Owing to the ahsence of Professor Winslov.- 
during the past month, the additions to the fund 
for the endowment of the department of path- 
ology have not been great, l)ut several very ac- 
ceptable sub.scriptions have been received. The 
sum total at present amounts to $753". to which 
may he added the Faculty of Physic fund, already 
in the hands of the trustees, amounting to about 
$0000, raised chieily through the efforts of Pro- 
fessor Cordell. tile new and the old subscriptions 
thus aggregating the (|uitL- respectable sum of 
$16,500. 

The subscri])tions to August I are as follows: 

Robinson be(|nest $5000 

Dr. ] lugh Hampton Young. J. H. V 100 

Dr. .S. j. Mehzer. LL.D.. New York 10 

Dr. ( iideon Timberlake 2^ 

:\lr. 11. P. Ohm 10 

Dr. .Samuel W. IMoore. D.D..S 25 

Hospital 1 lulletin 5 

Maryland Medical Journal 5 

Miss C. M. Selfe .S 

Prof. R. Dorsey Coalc, I'h.D 100 

Dr. John J. R. Krozer. 1848 50 

I )r. Eugene F. Cordell. 1868 10 

Dr. Joseph T. Smith. 1872 10 

Dr. W. J. Young, 1872 25 

Dr. Thomas A. Ashby, 1S73 too 

Dr. David \N'. lUilluck. 1873 '. 100 

Dr. Robert (lerstell. J873 5 

I )r. Randolph \\"in.slow, 1873 100 

1 )r. i I . T. ] larrison, 1874 S 

Dr. Cliarles \V. Mitchell. 1881 iod 

Dr. J. M. 1 Inndley. 1882 250 

Dr. 1 ienry Cbandlee. 1882 10 

Dr. j. C Perry. 1885 100 

Dr. I'.. .Merrill Hopkinson, 1885 2^ 

Dr. ] I. C. Reamer, 1885 10 

Dr. I'Vank Martin. 1886 100 

Dr. O W. Mcl'Ilfresh. 1889 too 

Dr. Saint Clair Spruill. i8()0 100 

Dr. Rui)ert I'.lue, 1892 loa 

] )r. 1 larry .\dlcr, l8<,)5 loo 



Dr. 

Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Th, 



Jose L. Hiish. t8<)5 30 

Joseph W. Holland. 1896 50 

R. W. Sturgis. 1896 2 

L. W. Armstrong. 1900 10 

S. Demarco, 1900 50 

M. S. Pearre. 1900 5 

J. D. Reeder, 190 1 30 

Nathan Win.slow. 1901 50 

.\rthur M. Shipley, 1902 250 

M. C. Davis. 1902 10 

H. L. Rudolf, 1902 ' 25 

I lugh r.rent. 1903 25 

Ci. C. Lockard, 1903 25 

Geo. S. M. Kieffer. 1903 23 

II. J. Maldeis. 1903 25 

R. C. }klctzel, 1904 10 

Robert V. Pay, 1905 100 

W. !•". Sowers. 1906 25 

l-'rank S. Lynn, 1907 25 

T. H. Legg. 1907 3 

E. H. Kloman. 1910 2^ 

imas C. P.asshor Co:n])any 10 

$7207 

To August I 330 



$7 



00/ 



L"\"l\ RRSITY op ^P\RYLAND SHOULD 

AJ'PE.VL T(j THE STATE FOR AID, 

.WD SHOULD RECEDE IT. 



P>\ the term L'niversity of Maryland is meant 
not a single department, but the school in its 
entiretv. and not a particular school of the Uni- 
versity. The various .schools of the LTniversity 
of Maryland have for years furnished the State 
with her jilnsicians. with her lawyers, with her 
])harmacists, with her dentists, and the Depart- 
ment of .\rts and Sciences has given the prelimi- 
nary college training to many of Maryland's 
most representative men. anil this fact is recog- 
nized and warmly commended, yet the aid which 
the L'niversity has received from the State is 
comparativcl\- little. 

The foreign cry that .\merieans worship 
money, and have no reverence for things who.se 
age alone should ensure them recognition, is not 
true of the L'niversity. The peojile of Maryland 
ha\e a lasting love and veneratiiMi for the old 
school which has served their fathers before 
them, and woidd sacrifice heavilv rather than see 



THE HOSPITAL BULLETIN 



115 



the L'nivcrsit)- lose in prestige or suffer financial 
reverses, and the one reason that more financial 
aid is not accorded ih.e L'niversity from the peo- 
ple of the State is that its claims have not been 
presented to them in terms sufficiently emphatic. 
There are men who have worked untiringly in 
the service of the L'niversity, and our love anrl 
esteem for them is great, yet this service and the 
upbuilding of its departments is a work too stti- 
[lendbus for any one man or for any ten men to 
acconi]ilish. It is a work that its teachers, its 
students, its alumni antl its admirers and bene- 
ficiaries alike nnist unite in, and with all their 
strength. Its claims must be made urgent, its 
needs made apparent. There is a settled convic- 
tion iin the part of the public of Maryland that 
the L'niversity of Maryland is a rich institution, 
else its doors had not been kept at their disposal 
these many years. The tales of sacrifice and the 
stories of personal endeavor so intimate to us 
are not and have never been public property, 
owing to a spirit of pride, false, it is true, but 
nevertheless noble. We can go on as we are now 
doing, and \-ear after year individuals must ])ay 
the price of our pride, while, on the other hand, 
an earnest appeal will) a truthful statement, 
backed up by proofs, of the exact financial needs 
of the L'niversity, presented publicly and forced 
upon the knowledge of Maryland legislators by 
worthy representatives of the school, cannot but 
secure the desired end. L^nless the L^niversity of 
Maryland receives adequate support from the 
State of Maryland it is not to be hoped that the 
efficient and distinguished service she has ren- 
dered this .State can be unabatedly continued. 

Today, while the L'niversitv is doing good 
work, seems the opportune moment for pressing 
her claims and for securing the aid necessary for 
the contimiance of that good work. Claims made 
upon i)rivate in<lividuals for sujijiort, long con- 
tinued, become burdens to the (lon(.)r, and alms tn 
the recii)ient ; claiiris made upon public bodies for 
supi)ort, periodically, become rights, the with- 
drawal of which is a ])ublic iniustice and is 
treated accordingly. To secure State aid for the 
Lniversity as a permanent factor in its welfare 
will rei|uire the strongest presentation of its 
needs before the coming Legislature. Once the 
fact is forced upon it that the L'niversity is reallv 
needy, the liattk- is won, and future appropria- 
tions will lie merely a matter of form, but the 
start must be made. Other schools, with vastly 



greater resources than tliose of the L'niversity, 
do not hesitate to press their claims, and are 
usually the gainers thereby. We would not ask 
that the L'niversity receive immoderate aid from 
the State; we would not have her lose her per- 
sonal independence: but we consider that the 
L'niversity of Maryland has done far more for 
the State of ]\[aryland than the State of Mary- 
land has ever done for the L'niversity, and any 
recognition accorded her, no matter how great, is 
merely a portion of her just due. The work of 
a select few of our alumni alone has been suffi- 
ciently distinguished to merit such regard, inde- 
l)endent of the combined work of our less cele- 
brated alumni, /V university ca])able of producing 
a Carroll, a Carter, a Ulue, a Councilman, is 
surely not derelict in its duty to the public. 

The public is with us, but they do not know 
our need. So boldly have we faced conditions, 
so excellent a front have we presented, that a 
tale of our need would be nnbelieved unless pre- 
sented by a re])resentative body of our men and 
in such straight, direct and forceful language 
that there can be no misunderstanding. We 
would suggest the securing of such aid as a field 
of vast possibilities for the work of the Advisory 
Alumni Council, and we would plead for the 
combined support of each and every person inter- 
ested in the old L'niversity. so that we can pre- 
sent in telling fashion our needs to the (ieneral 
Assembly of the State of Maryland on the occa- 
sion of its next meetino-. 



ITEMS 

Dr. Walter Colwell Gordon, class of 1907, of 
1250 Cranston street. Providence, R. I., writes: 
"The P)1'lli:ti.\ is always a welcome visitor, as 
it is the only means I have of keeping track of 
classmates and progress at the L'niversity." 



Dr. Charles W. Famous, class of mor. of Street. 
Md., is pronu'nenlly mentioned as a Democratic 
nominee for the House of Delegates from Har- 
ford countv, Marxland. 



Dr. Albert Hynson Carroll, class of 1007, v\rites 
from Wood's Hole, Mass,, wdiere he is spending 
the summer : 'T received your letter, and should 
have answered it weeks ago. My excuse is that 
when Dr. Hen".meter don't re(|uire me, T am busy 
at my work in the !\Iarine ]iiole)gical Laboratory. 



n6 



THE HOSPITAL BULLETIN 



Plenty of work all day. Evenone works here 
from early morning to late at niglit. Thev fanly 
eat work, they love it so. It is a very charming 
])lace, and affords most excellent facilities for re- 
search work." 



Dr. Calvm C. Peters of Princeton, W. \'a. ( class 
of 1906 ) has been recently appointed president of 
the Board of Health and Physician to the County 
Infirmary for Mercer county, West \'irginia, at a 
salary of $i8oo per }'ear. 

The ]iublishers of the P)L'I.i.f.tin are very desir- 
ous of securing the following copies of the IjTL- 
LETiN : July, 1905 ( \'ol. I, No. 5), January, igoy 
( \'oI. 2, No. 11), and March. 1908 ( A'ol. 4, No. 
i). We would be more than glad if some of our 
readers could send us these missing issues. 



Dr. Allen Kerr Bond, class of 1882, will reside 
in Forest Park in future. 

Dr. Cary Breckinridge Gamble, class of 1887, 
of 26 W. Biddle street, is spending several months 
in Europe. 



The members of the Baltimore County Medical 
i\.ssociation were the guests of Dr. G. Carville Mc- 
Cormick, class of 1890, and Dr. Frank Eldred at 
a crab feast at Penwood Grove, Baltimore county, 
July 19, 



Dr. Horace M. Simmons, class of 18B1, will 
spend the latter part of August at Rangeley 
Lakes, Maine. 



Dr. Henr\' J. ilerkeley, class of 1881, is sum- 
mering at Magnolia, Mass. 



Dr. Charles O'Donox-an, class of 1881, is sjjend- 
ing the summer at his summer home, W'ickiow 
farm. Phoenix, ]\ld. 



Dr. Joshua Royston (ireen, class of 189(1, o^ 
Towson, Md., has been six-nding some time at 
Cape May. 



Dr. Robert L. Mitchell, class of 1905, who we 
reported ill some time ago, has entirely recovered, 
and quite recently spent .some time on a trip with 
Dr, George M. .*-^ettle of Baltimore on the sailing 
yacht Grace. 



Dr. Thomas Chew Worthington, class of 1876, 
is spending the summer in Massachusetts, as is 
his custom. 



Dr. Ephriam Hopkins, class of 1859, is located 
at Darlington, Md. Dr. Hopkins has been in prac- 
tice here over 50 years, and has won the admira- 
tion of all bv his devotion to his work. He is a 
member of the Society of Friends, and includes 
among his patients almost all the Friends in that 
vicinity. 



Dr. Walter B. Kirk, class of 1893, is also located 
at Darlington, Md.' He is vaccine physician for 
the fiftli district of Harford county, and sanitary 
officer for the entire countv. 



F)r. b'rank I^. Smithson, class of 1880, is located 
at Forest Hill, Harford count}', Md. l^e was for 
man-\' years vaccine physician for Harford county. 



Dr. Randolph Winslow, class of 1873, has re- 
turned to his home in Baltimore after a trip to the 
Pacific Coast, the Yellowstone Park and the 
Grand Canon of the Colorado. 



A committee of the Baltimore County Medical 
Society is sending circulars to members asking 
subscriptions to purchase a portrait of Dr. James 
H. Jarrett, class of 1852, The portrait will cost 
about $250, and is to be hung in the hall of the 
Medical and Chirurgical Faculty of ^laryland. 



Dr, John Evans Mackall, class of 1908, who 
was assistant surgeon at the Atlantic Coast Line 
Railroad's hospital at Rocky Mount, N. C, has 
resig-ned and returned to his home at Flkton, Md. 



.\ letter from Dr. J. C. Perry, class of 1885, of 
Ancon, Panama, says in part: 

"I am enclosing check in amount $100 for the 
endowment fund, and our alma mater has my 
very best wish for success and a continuation of 
the good work it has done in the past. 

"We (the class of 1885) are so scattered that 
a class reunion seems impossible, but I know of 
no event that would cause me more pleasure." 



Dr. Henry Chandlee, class of 1882, will spend 
August at his camp in the Thousand Islands, 
Canada. 



THE HOSPITAL BULLETIX 



117 



Dr. B. Merrill Hoplcinson, class of 1885, who 
has for the past 2[ years heen choir director ami 
soloist at Brown Memorial Presbyterian Church, 
has resitjned to accept a similar position at St. 
Michael and All Angels' Protestant E])iscopal 
Church. 



Dr. Arthur K. Cannon, class of T()0q, of 821 
Xorlli I'remnnt avenue, ISaltimore, Aid., will 
make his future liome in S])artanburo-, S. C. 



llishiip Luther 1!. Wilson of I'hiladeli.ihia, a 
i^'i'aduate <if the medical dejiartment of the L"ni- 
versity of Maryland, class of 1877, and son of 
Dr. Henry Al. Wilson, class of 1850, of 1006 
Madison aveiuie, llaltimore, is ill with an attack 
of .African fever and heart trouble at the Thack- 
eray Infirmary, London, Euf^land. The latest re- 
ports sa\- that he is now well on the road to 
recover} . 

Bishop Wilson was stricken by the fever while 
in Beria, Portuguese East iVfrica, in the early 
part of June. ( )n June 16 his heart became af- 
fected, and for 10 days his life was despaired of. 
However, he slowly began to improve, and as 
soon as his condition was considered strong 
enough to stand the trip he was moved to Eng- 
land, arriving in London on Saturday, July 15. 
Since arriving in London his convalescence has 
been rapid, and at the present time it is expected 
that he will return to his home, in Philadelphia, 
by September. 

Before he was stricken Bishop Wilson had 
spent about seven months in Africa. During that 
time he had traveled over a great part of the 
continent. 

Even before he was made a bishop. Dr. Wilson 
was well known in the Methodist Episcopal 
churches of this city. Bishop Wilson studied 
medicine at the L'niversity of Alaryland after 
graduating from Dickinson College. He grad- 
uated and then practiced medicine for one year 
before he entered the ministry. 

II is first ap])ointment was under Rev. W'atson 
Case of the Hancock circuit. He was next pas- 
tor at Calverton ; then at Clipper Church, Wood- 
berry ; Jackson Square and Strawbridge churches. 
He served two terms as one of the presiding 
elders of the conference. 

However, one entire term intervened between 
his first and second incumbencv. His first term 



he was presiding elder of the W'ashington district 
and the second of the West I'altimore district. 
During the interim between his terms he served 
as pastor of I-'oundry Church, in Washington, 
lie presided at the conference receiUly held at 
1 larlem Avenue Church. 

He was made a bishop at the conference in Los 
Angeles in 1904. At first he went to Tennessee, 
where he served for a time, when he was trans- 
ferred to Philadel])hia, which is still his head- 
quarters, his trip to Africa being onlv temporary 
work. 

I'ishop Wilson has always been deeply inter- 
ested in the work of foreign missions. As far 
back as igo6, just two years after his appoint- 
ment, he was mentioned in the filling of a vacancy 
as one of the missionary bishops in Africa, and a 
short time later there was talk of the church send- 
ing him to China. However, it was not until last 
fall that he really was calle<l upon for some work 
in foreign fields. 

His wife was a Miss Turner. 

W'e sincerely hope that in our next issue we 
may be able to report that Dr. Wilson is fully 
restored to health. 



Among the candidates who successfully ])assed 
the Maryland State LSoard examination were the 
following : 

Burt Jacob .\ster, Walter Coniplon Bacon, 
1 '.euhler Shoup Boyer, William Luther Beverly, 
Henry Dickinson Causey, Herbert Augustus Cod- 
ington, Louis Harriman Douglass, Charles L. 
Dries, James Joseph Edelen, Abraham Lewis 
llornstein, Kenneth B. Jones, Charles Hutchin- 
son Keesor, Charles R. Law. Jr., Isaac Michel 
.Afacks, George Yellot Massenburg, Walter Sauls- 
bury Niblett, Elijah Emera Nichols, Vernon 
Llewellyn Oler, John Ostro, James Earle Quig- 
ley, Stanley H. Rynkiewicz, Charles Louis 
.Schmidt, Joseph Stomel, Ralph Leland Taylor, 
( irafton Dent Townshend, Albert G. W'ebster, 
Richard Lloyd Williams, all of the class of 191 1, 
and R. Gerald Willse, Charles A. Neafie and 
George E. Beimett, class of 1900, and William A'. 
Parramore and Xalhaniel (iarb, class of 1910. 



Dr. George Walter, class of 1910, formerly of 
P)altimore, has opened an ofifice at 131 West 
Adams street, Jacksonville, Fla. 



ii8 



THE HOSPITAL BULLETIN 



Tlie clinical assistants at tlic University \ los- 
pital for the coming year are ; 
R. E. Abell, South Carolina. 
R. A. Allg'ood, South Carolina. 
R. Cj. Allison. .South Carolina. 
G. C. Battle. North Carolina. 
11. A. Bisho]), District oi Coluniljia. 
R. A. Bonner, Jr., Maryland. 
S. K. Buchanan, North Carolina 
W. T. Chipnian, Delaware. 
W. R. Claytor, South Carolina. 
J. D. Darby, Maryland. 
R. II. Dean, Jr., Florida. 
11. Deibel, i\Taryland. 
J. A. Duggan, Georgia. 

I. I""ajardo, Cuba. 

W. E. Gallion. Jr.. .Maryland. 

D. (). George, Maryland. 

J. E. Hair, Jr., South Carolina. 
H. Irwin, xN'orth Carolina. 

E. S. Johnson, Maryland. 
J. K. Johnston, Florida. 
G. M. Lebret, New Jersey. 
M. L. Lichtenberg, .Maryland. 
A. G. Martin, Cuba. 

W. Michel, Jilaryland. 
Bcnj. Newhouse, Maryland. 
R. B. Patrick, South Carolina. 

C. W. Rauschenbach, Marxdand. 
W. M. Scott, Georgia. 

J. D. Sharp, Indiana. 

D. Silberman, Maryland. 
G. A. Stem, Maryland. 
J. H. Traband, Maryland. 
L. J. Vega, Cuba. 

M. N'inciguerra, New Jersey. 

II. R. Wiener, Pennsylvania. 



Dr. Rufus b'rankliii. class of 1907, of Gray- 
mount, Ga., was a recent visitor to Baltimore. 



I )r. Charles l''i-aiiklin .Strosnider, class of 1909, 
of Clinton, .N. C., writes: "I am now in charge 
of 10 free hookworm dispensaries in Sampson 
county, under the auspices of the State and county. 
I have a microscopist ; we make microscopical ex- 
aminations and administer the treatment free. 
The dispensaries are very popular ; am finding 
about 70 per cent, of all ages positive. Will run 
the dispensaries about six weeks in this county." 



.\ letter from Dr. Charles Wesley Roberts, class 
of i(joi>, of Douglas, (ia., says: "This fall I ex- 
pect to pay a visit to the oUl L'niversity, and I 
trust 1 may have the pleasure of renewing my 
acquaintance with a host of the good friends I 
once claimed at the University as teachers or 
graduates therefrom." W'e will all be \er_\- glad 
to welcome Dr. Roberts. 



Dr. I'itzRandolph ^\'insll,lw, class of 1905, has 
left on a trip to Jamaica and the West Indies. Jn 
a letter from the Hotel Camaguey, Camaguey, 
Cuba, he writes : "I arrived at a little Cuban sea- 
port several hours after the train for Camaguey 
had i)ulled out, so was compelled to stay in limbo 
for 24 hours, as nothing else was going my way 
until today at 7.50 A. M., which arrived here about 
3.30 P. M. The train stopped frequently at mere 
shacks, Init I felt as though it was running rather 
fast. As this is a rather high altitude, I am not 
being bothered by the heat. This is the rainy 
sea.son, but one is not bothered bv it. Like most 
things that people talk about, I have heard all 
sorts of conflicting statements about places and 
customs, and generally find out that only a few 
knew what they were talking about. Everybody 
seems agreed on one point, however, and that is, 
that Santiago de Cuba is a mighty hot place, but I 
have decided to go there and take the boat for 
Jamaica from that point." 



Dr. Coale is in receipt of the following kind 
and interesting letter from Dr. .V. ^\'. Giami)ielro, 
class of 1907 : 

"Dear Dr. Coale. — It is my pleasure to enclose 
herewith a carbon copy of a preliminary investi- 
gation concerning the role that the bacillus coli 
plays in vegetable pathology. This paper will be 
published through the Department of Agriculture, 
but r wish you would also publish it in your FIos- 
rriwi. Bri.i.inix, as my first scientific contriliution 
to my alma mater. 

"1 am now conducting a comparative study 
with bacillus coli, thyphosus and mesentericus 
vulg. as to their relation to ])lant diseases, and as 
soon as the investigation is completed I will try 
to conic to the University and have a conference 
with the alumni and ])rofessors about this very 
im])ortaiit branch of ]iathology. 

"In view of the fact that I am indebted to the 
Unixersity of .Maryl.-ind for many opportunities 



THE HOSPITAL BULLETIN 



119 



offcrecl to nie when a stuik-nt. 1 feel an obligation 
to give her full honor and credit for what she i-> 
as a reproach to those who have tried to degrade 
her in every respect. 

"Since the few- and only preliminary works of 
Laurent, my investigations are the first to appear 
on this subject, and I believe will interest every 
bacteriologist. 

"Hoping you will accept my contribution as a 
token of appreciation of the L'niversity ami cif 
yourself, I beg to remain. 

"Sincerelv \ours. 

"A. W. Gl.\MPIKTRO." 

Dr. Giampictro's article appears elsewhere in 
Till-: r.ui.i.KTix. 

Dr. Edward J. ISernstein. class of 1887, of Sio 
Kalamazoo National Bank Building, Kalamazoo, 
Mich., writes that "we get along merrily and en- 
joy life." Dr. Bernstein limits his practice to dis- 
eases of the eve. ear, nose and throat. 



Dr. Bennett F. Bussey. class of 1884. of Texas, 
;\ld.. was a recent visitor to the University Hos- 
]ntal. 



Amongst our Alumni located in North Caro- 
lina are the following : 

AI.\TTHEWS. 

Harry O. Ale.Kander, class of 1898. 

]\Iaxtox. 
Arthur Baxtom Croom, class of 1905. 
H. ^^■ise .McNatt, class of 1881. 

Mir.LINGPORT. 

Daniel P. \\"hitley. class of 1889. 

;\loncure. 
W. J. Strickland, class of 1890. 

yio'SROE. 
Samuel Amos Stevens, class of 1900. 
Henry Dixon Stewart, class of 1898. 

^lOORESVILLE. 

.\ndrew E. Bell, class of 1897. 

MOREIIE.M) CiTV. 

William E. Lleaden, class of 1891. 

2ll0RG.\NT0N. 

Charles E. Ross, class of 1889. 

'SlORVKN. 

Dunlap Thoni])son. class of 1901. 



JiloUNT Ol.I\ E. 

W illiani C. Steele, class of 189T. 

Mount Pi.sg.mi. 
Gurley D. Moose, class of 1907. 

Nasii\ii.le. 
James P. P.attle. class of 188S. 
J. T. Strickland, class of 1890. 

Newp.erx. 
Robert Duval Jones, class of 1896. 

Newport. 
Oswald Ottmar Kafer, class of 1905. 

Newtox. 
James R. Campbell, class of 1876. 
^\'illiam H. Everhart, class of 1903. 

Norwood. 
Thomas A. Hathcock. class of 1893. 

O.AK Ridge. 
John Robert Pattison, class of 1902. 



Of the class of 1874 we are able to locate the 
following : 

Howard E. Ames, U. S. N. 
Joseph S. Baldwin, Freeland, ^Id. 
R. C. Buck, Orlean, Va. 
M. S. Butler, Hedgesville. \V. \"a. 

D. L. Cheatham, Sandersville, Ga. 

A. P. Dodge, Hickok block, Oneida, N. Y. 

Elisha C. Etchison, Gaithersburg, Md. 

Rezin Warfield Hall, ]\Ioundsville, W. \'a. 

Henry T. Harrison, Loch Raven, Md. 

J. Rufus Humphrey. Ely, j\linn. 

Col. L. M. Mans, Federal Building, Chi- 
cago, 111. 

C. C. McDowell, 1521 West Fayette street, Bal- 
timore, Md. 

E. S. Miles, Upper Fairmont, Aid. 

Eldridge C. Price, 1012 Madison avenue, Bal- 
timore, Md. 

O. FI. W. Ragan. Hagerstown, Md. 

T. E. Sears, 658 \\'est Franklin street. Balti- 
more, Md. 

John T. Shepherd. Loveman Building. Chatta- 
nooga. Tenn. 



-Vt the recent annual meeting of the JNIedical 
and Chirurgical Faculty of Maryland the follow- 
ing alumni were elected to official positions : Dr. 
John L. Riley, class of 1905, of Pocomoke City, 
and Dr. Daniel E. Stone, class of 1864, of Mount 
Pleasant, Md., vice-presidents; Dr. James W. 



120 



THE HOSPITAL BULLETIN 



Humrickhouse, class of 1873. ^^ Hagerstown, 
Md.. trustee : Dr. Charles O'Donovan, class of 
1881 ; Dr. Lewis C. Carrico, class of 1885. of 
Rryantown, Md. ; Dr. James E. Deets, class of 
1882. of Clarksburg, Md., and Dr. Harry B. 
Gantt, class of 1880, of Millersville, Md., coun- 
cilors; Dr. G. Lane Taneyhill, class of i8ri5, of 
Baltimore, delegate to the .Vmerican Medical As- 
sociation, and Dr. James H. Carroll, class of 1893, 
of P.altimore, alternate. 



MARRIAGES 

Dr. -Lewis Morris, class of i8<jo, surgeon in 
the United States Navy, was married on August 
I, 191 1, to Mrs. Ella Bingham Duffy. The cere- 
mony was performed by Rev. \\'illiam Courtney, 
assisted by Rev. Matthew G. Gleason, chaplain of 
the B.rooklyn Navy-yard. After a motoring trip 
through New England the couple w'ill reside in 
New York. 

DEATHS 

Dr. P'rederick I'.irdseye Baker, class of 1888. 
died of apoplexy at his home in East Norwalk on 
April 17, i()ii. aged 55 years. He is survived 
by a wife, a daughter and a son. Dr. Baker was 
born in Warehouse Point, Connecticut, on May 
9, 1855. He was a member of the Masonic Or- 
der, of the Knob Club, the South Norwalk Club, 
the East Norwalk Yacht Club, the Mayflower 
Hook and Ladder Company, the Norwalk Medi- 
cal Association, and was a director of the South 
Norwalk Savings Bank. His sudden demise was 
a great shock not only to his family, but to the 
community in which he lived. He was loved and 
is moiu'ned b\' manv. 



Dr. George A\'. Truitt, class of 1875. died at 
his home in Roland Park, Md., July 11, 191 1, at 
6 P. M. of ])aralysis after an illness of two years. 

Dr. Truitt was the son of the late Rufus K. 
Truitt, who was a druggist in Salisbury, Md. 
Dr. Truitt obtained his ear!\- training in the ])ub- 
lic schools of Salisbury and came to Baltimore 
when a young man. He entered the medical de- 
partment of the University of Maryland, from 
which he was graduated in 1875. Lie went to 
Salis])ury and practiced medicine for 12 years. 
He was a member of the Legislature from Wi- 
comico county in i8<)0. 

In i8<)7 Dr. Truitt came to Baltimore and 
bijught a pharmacy in Roland Park, which he 



conducted until his death. In 1900 he was elected 
a member of the Legislature from Baltimore 
county. 

He was deputy insurance commissioner of 
Maryland for 12 years. 

He was buried in Druid Ridge Cemetery. Dr. 
Truitt is survived by a widow, who was Miss 
Helen D. Wolf of Baltimore. 



LABORATORY REPORT OF THE UNI- 
VERSITY HOSPITAL. 
Month oi" July. 
Blood Examinations. 

Leucocyte Counts 169 

Erythrocyte Cotmts 15 

Differential Leucocyte Counts 11 

Hemoglobin Determinations 62 

Smears for Malarial Parasites 10 

Blood Cultures 4 

Wasserman Tests 24 

Wldal Tests 48 

Blood Pictures 4 

347 

Urine Examinations. 

Routine Urinalysis (chemical and micro- 
scopic ) 3r)0 

360 

Misccllancons. 
Gastric Contents (chemical and micro- 

sco|)ic ) II 

Feces ( microscopic, etc. ) 14 

Sputum Examinations 12 

Bacteriological Cultures and .Smears 

( from operative cases) 18 

Bacteriological Smears ( non-operative 

cases) 6 

Spinal I'luid Examinations i 

Pleural Fluid Examinations 3 

Anti-typhoid \'accines (kindness of Drs. 

Stoner and Hachte!) 90 

Auto])sies 2 

Section of Tissue for Microscopic Ex- 
amination 14 

171 

Total 878 

Dr. J. L. HiRSH, 
Dr. H. J. M.\LDEis, 
Dr. L. K. Walkicr, 
W. M. Scott, . 
F. S. loii.N.soy. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest o£ the Medical Department of the University of Maryland 
PRICE f l.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., SEPTEMBER IS, 1911. 



No. 7 



A HURRIED TOL'R THROL^GII RUKoriC. 



I'.v T. A. A^^iiiiv, M.D. 



The dreams of many years were fully realized 
when, on the morning of July 14, I landed in old 
England after a safe and pleasant passage across 
the Atlantic. The good steamer in wiiich 1 had 
embarked anchored in the splendid harlior of 

I Liverpool at i o'clock A. AI. We were detained 
on board until the health officers and custom- 
house inspectors gave us permission to go ashore. 
At 6 o'clock in the morning \vc climbed down tin- 
side of the steamer on a long ladder to the dock 
of a tug. which conveyed us to the shore landing. 
This gave us a splendid opportunity to see the 
great harbor of Liverpool with miles of dock^ 
and hiuidreds of vessels of every description en ■ 
gaged in the commerce of that city, which is said 
to be the third in size and tonnage of any city in 
the world. London ranking first and IlaniljiirL;' 
second. 

After landing we made search for the best 
liotel we could find, and for the first time since 
leaving home enjoyed a real breakfast, .\fter 
breakfast my friend, Mr. W. C. Page. ]:)resident 

. of the Calvert Bank, who was my constant com- 
panion during my trip abroad, and I took a cab 
.nid for several hours were driven through the 
l)usincss and residential sections, the public parks 
and such places of interest as were within our 
reach. We found much to admire in the solid and 
lieautiful city of Liverpool, with its population of 
some yoo.oo'o ijeo])le. with its splendid public 
and private Intildings, monuments and institutions, 
all showing greatness of accumulated wealth dur- 
the centuries since the city had had its birth. A\'e 
saw enough of Liverpool to impress us with the 
fact that cities of wealth and of solid growth, 1 
of sulistantial and stately buildings, of splendid,' 



streets and noble jiarks are tiie products of years 
anil even centuries of earnest labor and uninter- 
rupted progress, of sound civic government and 
a high-spirited citizenship. Great cities, like 
great oaks, must grow slowly to secure a hard 
fibre and long life. The large centers of popula- 
tion we visited during our travel through Europe 
iiave Ijeen centuries in reaching their present size 
and importance. This slow process of growth, 
contrasted witli the rapid way Ainerican cities 
liave sprung up, explains the difference in the 
architecture, public and private buildings, streets, 
water supplies, sewage and illumination observed 
in European cities and those found this side of 
tiie Atlantic. It has taken centuries in Europe to 
construct the splendid architectural monuments 
w hich are the chief ornaments of European cities. 
Many of the great buildings, churches and gal- 
leries of art had their foundations laid long be- 
fore Columbus crossed the Atlantic. It is the 
element of time wdiich has given reliability and 
endurance to the civilization of the Old World. 
Apart from this, with the vigor and rapid growth 
of American ways and methods we are fast ap- 
proaching, and will in no distant day go beyond, 
all European models. 

After a thorough view of Liverpool we took the 

.Midland Railroad for London, wdiich may be 

reached in less than five hours, the distance being 

over 200 miles. The ride through rural England 

was a most enjoyable one. Tiie railway service 

was by far the best we had in Europe. The train 

carried us through a number of large cities and 

many villages, but stojis were made at few places. 

The country was most picturesque and beautiful 

in many ])laces. As we passed by the Peaks of 

, Derby the cars carried us through the most per- 

■ feet scenery of mountain and valle\', in which 

'■Sevcry acre of land had been cleared of timber and 

Jwas covered with a velvety green pasture, giving 



122 



THE HOSPITAL BULLETIN 



support to lierds of stock. Tliese highl_\- culti- 
vated mountain lands show to what high art farm- 
ing has been carried in England. Every acre of 
ground has been utilized by man, and must pay 
tribute to human industry. The harvest was just 
ripe as the train Ijore us through fields of oats, 
golden wheat and meadow lands filled with labor- 
ers gathering in their crops. The more level 
farm lands of Leichestershire were less evident 
in cultivation, but herds of splendid cattle and 
flocks of the Southdown sheep were browsing 
in pastures which would bring joy to the Ameri- 
can farmer. There is so little waste land in Eng- 
land that intensive farming is practiced in a skill- 
ful way. I saw no corn in cultivation in any por- 
tion of Europe through which I traveled. Wheat, 
oats, hay, potatoes, hops and barley are the staples. 
In England and Holland I saw large and beautiful 
herds of cattle and some superb horses. 

We reached London at 5 P. M. July 14. and 
were driven in a taxi to the Inns of Court Hotel 
in the very heart of old London, just across the 
street from Lincoln Inns Fields. \Ve found most 
pleasant accommodations, and from the close 
proximity of the hotel to noted London objects of 
interest we were able to visit the scenes of his- 
toric interest close by made famous by the pen 
of Dickens and by lioswell in his "Life of John- 
son." The Old Curiosity Shop still stands, a 
lonely relic of the past, within two blocks of the 
hotel. Fleet street, now a great business center, 
was not far away from the Old Curiosity Shop. 
As I recalled the famous men of literature — Sam 
Johnson, Oliver Goldsmith, David Garrick, Sir 
Joshua Reynolds, Edmund ]]urke and others 
whose lives were so intimately associated with 
this section of London — I could not escape the 
conviction that time works havoc v\'ith the monu- 
ments of man, but his glory is imperishable if 
once faithfully recortled in the historv of his gen- 
eration. 

After a bath and good dinner Mr. Page and I 
left the hotel for a stroll through London. As 
the dusk in England does not deepen until after 
9 o'clock, we had a good hour of daylight for 
sightseeing, which we used until our feet were 
too tired for further walking. We then took a 
taxi and, giving instructions to the chauft'enr 
where we desired to go, for some two hours we 
were whirled through the streets of London at a 
pace that was almost too fast for solid comfort. 
We nnist have covered some 35 to 40 miles, for 



we visited St. Paul's, The Tower, crossed Tower 
Pridge, returned by London Bridge, coursed along 
the embankment to House of Parliament next to 
Westminster Abbey, to Buckingham Palace, the 
city residence of George V; through St. James.'^^ 
Regents' and Hyde Parks, and then through 
much of the business and residential sections of 
the city. London is beautifully illuminated with 
incandescent lights, and as traffic is light at night 
a taxi is able to cover long distances with great 
ease. The streets of London are the best paved 
I have ever seen. The taxi service cannot be ex- 
celled, as it is well-nigh perfect. We rode for some 
two hours, and when we came to pay for the serv- 
ice, the meter registered eight shillings (about ^2 
in American money). We gave the chauffeur 
two shillings as a tip, wdiich he acknowledged 
with so much politeness that we believed we had 
given more than the accustomed allowance. This 
ride after night gave a most charming impression 
of London. When we retired to our rooms we 
were worn out with the fatigue of the d.ay. Hav- 
ing landed in Liverpool at 6 o'clock in the morn- 
ing, b_\- II o'clock P. M. of the same day we had 
traveled many miles by cab, rail and taxi ; had 
seen many new and interesting objects, and ha<l 
registered many impressions which v.ill linger 
until our brains cease to function. I had smoked 
so many cigars during the day, and my brain was 
so charged with the experiences of my first visit 
to England, that it w^as long after midnight be- 
fore I fell into a deep sleep. .\t 8 o'clock the fol- 
lowing morning I was up and dressed as fresh 
in body and mind as a boy taking his fir.st outing. 
After a good English breakfast we decided to see 
on foot the banking section of London, and to 
visit, especially. Brown, Shipley & Co. and 
Thomas Cook cS: Sons, with whom we had letter-^ 
of credit, and from the latter of whom we were ti < 
secure tickets for tra\'el through lun'ope. I can- 
not say too much for the courtesy and wonderful 
system of this latter Imuse. They iiavc agents in 
every important city in F,uro])e, and book the 
tourist over routes which he could scarcely make 
without their assistance. 

Our business was finished by 10 o'clock, when 
we went to Westminster Abbey and Parliament 
House for closer inspection than we had had the 
evening before. My visit to both of these places 
w-as rather disappointing. I had expected to see 
in the interior of these buildings more imposing 
sights and more interesting objects than those 



THE HOSPITAL BULLETIN 



t-'3 



])r(.>(.-nU-il. The Ahhcv' in the iiUcrinr is nnicii 
miuiIIlt than its uutward apiiuarancc wnuid indi- 
caU". At the time nf my visit it was crowtlo'l 
witii tile stands and chairs used durino- the re- 
cent coronation. ]\Fany of the monuments to 
{'jii^hmil's noted dead were hidden from view. 
We could only see those high up on the walls or 
imder the ritK)r over which we walked. It was 
difficult to realize that we stood in the presence 
of all that remains of England's Iniried rulers, 
statesmen, soldiers, poets, scientists, scholars and 
men of renown now sleeiiiiig heneath the lofty 
roof of the .\l)bey. I thought to myself, What 
does it ])rolit these dead to sleep in this cinise- 
crated ])lace? Are they aii}- better off than luil- 
lions who lie buried under many a forgotten 
mould of clay? Yet one must realize that luen 
have endured every act of human t(3il, ha\'e 
braved all danger. ha\'e sacrificed blood and treas- 
ure, have li\'ed in the jungle with savages and 
beasts of prey or in climates and situations nn 
suited to health of body and mind all for the dis- 
tinction and glory of a long sleep in the dark 
house and gloomy halls of this old rantheon. 

The onl_\- satisfaction I had in my visit to the 
.\bbey was a close view of the chair in which the 
kings of h'ngland have been seated during corona- 
lion and the stone of Schone resting under the 
chair which for over 1200 }'ears has been present 
at these exercises. 

The House of J'arlianient on the Thames em- 
bankiuent is a stately structure. Its interior is 
l)eautifully embellished with i)aintings and statu- 
ary representing luany of England's kings. c|ueens. 
princes and nobles, as also her greatest statesmen, 
orators and soldiers. The Halls of I'arliament, 
both Lords and Common, are contracted and un- 
comfortable ])laces for conducting business. ' ,\s 
contrasted with our own Cai)itol at Washington, 
the comjiarison is all in favor of our country. 

I do not hesitate to say that the i iall at Anna])- 
olis in which the House of Delegates meets is -.x 
more elegant and comfortable place for the con- 
duct of legislation than either of the Halls of 
I'arliament. 

r>uckiugham I'alace. tiie city residence of the 
King, is an enormous building, covering much 
ground and surrounded by beautiful gardens and 
|)arks. Its e.xterior is dark and dingy, and could 
be greatly improved by a coat of paint. As I 
<lid not enjoy the privilege of seein.g the interior 
of the palace, I must imagine it is very beautiful 



to make up for the homeliness of its exterior, 
w hich looks more like a large hospital or reforma- 
tory institution than the home of a king. Tiie 
l)eautiful flowers around the palace, the artistic 
way in which the_\' are cultivated with variations 
of color and the appeal which they make to one's 
letined sense of taste are in striking contrast 
with the building which they surround. 

In the afternoon and evening we took our third 
lour over London in a taxi. During this trip we 
had the agreeable society of several lad_\' friends 
from .\merica visiting London. We rode for 
many miles and saw a few of the places we had 
\isited before and many new objects of interest. 
I began to feel that I knew London perfectly well, 
yet it is an enormous place, covering miles of terri- 
tory, with its 6,000,000 or more of people. 

Sunda\' is a day of rest in London. We ob- 
st'rved the morning by going to religious exercises 
held in St. I'aul's. This grand and massive tem- 
]ile, erected to the worship of God over 200 years 
ago, still stands as a moiuiment to the genius of 
its architect. Sir Christopher \\'ren. Though 
stained and worn by the uses of time, St. Paul'- 
is. to ni_\- mind, the most impressive building in 
London. There are others larger and more costly, 
but none which create such feelings of respect and 
\'eucration for all that is noble in art or beneficial 
in its services to man. The religious services, con- 
ducted by the clergy of the Church of I'jigland, 
were so ])ure and elevating that the spirit of rev- 
erence must steal its way into the hardest soul. 
The music rendered by the organ and chorister 
lioys, the chanting and responses rang through 
the great halls and dome of the building in sweet- 
est notes I have ever heard. There was a dignitv 
and refinement in the service that made my soul 
feel that I was in the real presence of those spirits 
w ho are said to make music around the throne f)f 
the (ireat King of Kings. 

.St. Paul's is a wonderful house of worship, and 
a grbat monument to iuigiand's religicnis life. 
Such temples, made with human hands, are splen- 
did types of that House not luade with hands 
eternal in the heavens. The glory of the earthlx' 
is a symbol of the glory oi the heavenly. 

As I stood on the broad pavement in front of 
St. Paul's and looked at her immense walls, mag- 
nificent columns and loftv dome reaching far up 
toward the heavens, my mind involuntarily re- 
called the prophetic words of Macaulav in his 
comments on the Church of Rome, where he sav.< : 



124 



THE HOSPITAL BULLETIN 



"She iiia_\' still exist in undiminished viii'or when 
some traveler from New Zealand shall, in the 
midst of a vast solitude, take his stand on a broken 
arch of London Bridge to sketch the ruins of St. 
Paul's." I thought whilst such a jirophecy 
might some far distant day be fulfilled, as all ma- 
terial structures are i)erishable, that the sjiiritual 
truths for which St. Paul's now stands are per- 
haps as imperishable as the human soul, and for 
all time will hold out to the heart of man the hope 
of glory and promise of eternal life. J turned 
away from St. Paul's feeling that our best inter- 
ests in this life and our dearest hopes of a life 
beyond are greatly ennobled by these magnificent 
tem]ik's constructed 1>\- human hands to Divine 
service. 

Monday was given exclusively to the llritish 
Museum and hospitals of London. As soon as 
the doors of the museum were thrown open to 
visitors I entered this great storehouse of art, 
literature and ancient lore. The building, large 
and imposing, covers many thousand square feet 
of space in the very heart of London. Its various 
rooms, halls and galleries are loaded with collec- 
tions covering almost every de])artment of human 
learning, coming down fron-i prehistoric times to 
the present day. In its diflr'erent rooms can be 
found the relics of every ancient civilization ar- 
ranged and classified so that the student can 
gather an enormous amount of information on 
almost every subject. I was cliietl\' interested 
in the archaeological department, assigned to the 
( irecian and Roman collections, and gave the 
greater portion of my time to an examination of 
the classic works of sculpture and architecture 
brought from Greece and Italy. ^Farlile busts 
.•md statues of (Irecian characters and of Roman 
kings and emperors are wonderfully well ])re- 
served. and ])resent life-like portraits of the dis- 
tinguished men they rejiresent. One seems to 
stand in the very presence of the Caesars, Julius, 
.Augustus, Tiberius, Nero and many others' the 
.\ntonines, Severus, Caracalla — men who either 
ennobled or degraded Rome, now chisled in 
marble with nnble features or mean and >ensuous 
expressions. 

The collection of (Irecian architecture is very 
artistically arranged. .Along the walls of the n)om 
are renuiants of the frieze from the Parthenon at 
-Athens, brought to England some years ago by 
Lord I'^lgin. 'I'his frieze. re])resenting in sculp- 
tured marble the I'anatheanic festival in verv 



li.w relief, is 3 feet 4 inches in height and 520 feet 
\v length. Many of the slabs of the frieze have 
been broken and lost, but have been restored in 
]jlaster of paris, which is placed below the original 
and gives a perfect representation of the highes: 
attic art. The Partheon and the Acropolis have 
been restored in miniature and stand out in 
the hall of the museum as an almost perfect type 
of Athenian architecture. The Egyptian collec- 
tion is of equal interest to the antiquarian. It is 
full of mummies and mununy cases, and of rem- 
nants from ancient Egyptian temples. 

I was much interested in the collection of an- 
cient and even more recent manuscripts, letters 
and autogra])hs, so well preserved as to be legible. 
Letters in the handwriting of many of the kings 
and c|ueens of luigland and of numerous men of 
distinction, from Chaucer down to the present 
generation, are open to inspection under glass 
covers. One could spend weeks in the museum 
with eijual interest and profit. My visit was a 
very hurried one, but I brought away with me 
verv vivid impressions and luuch food for thought 
and meditation. 

I next made a hurried visit to Middlesex Plospi- 
tal, in the center of London, near Oxford Circus, 
and only a few blocks from Regent's Park. This 
institution was founded in August, 1745, and 
from small beginnings has grown to its present 
size, its buildings now covering several acres of 
ground with a capacity of 340 beds. The number 
of in-patients treated during the year 1910 was 
5434, and 54.240 out-patients. The total expendi- 
tures of the hospital were about $175,000, with re- 
ceipts slightly less. These figures are given to 
show the size of the institution. Through the 
courtesy of the resident officers I was conducted 
through the hospital by the superintendent of 
nurses. 1 had a good ojjportunity to see the char- 
acter of the buildings and the conduct of the work. 
.At the time of my visit, midday, there were no 
o])erations going on. There was much activity 
about the buiklings, and extensive repairs were 
being made in some of the wards. I have few 
comments to make, as I saw very little to condemn 
or to praise. The buildings and grounds were 
in good condition, and the hospital seemed to bo 
doing its work along modern lines and in that 
conservati\e wa\- characteristic of English meth- 
ods. The Middlesex Hospital Medical School, a 
school of the L^niversity of London, is conducted 
in connection with the hosjiital. It is fully equip- 



Tllli HOSPITAL BULLETIN 



12 = 



pctl I'lT the tliforclical and practical teaching of 
all the -ul)jccts connected with tlie medical cur- 
ricuhim. i'.very student liefore entering a medical 
schdiil in JMi.uland cir registefini;' his name at the 
I icneral .Medical Coiuicil must produce evidence 
of havini^' i)asse(l a preliminary examination in 
>nch siihjects of t;eneral education as are acce])ted 
hv the various exaniinini;- hodies to whose exami- 
nations he intends to proceed, and must have at- 
tained the a!.;e of if) years. 

The .Middlesex Hospital Medical School has .i 
large facidty and coqjs of teachers and an annual 
attendance of some 300 students. The system of 
instruction is largeiN' clinical and laboratory. 
There is little, if any. didactic leaching. The 
fees for instruction are about the same as are 
charged Ijy the best schools in this country. There 
are a number of students' clubs and an athletic 
ground of some eight acres within easy access at 
Park Royal, where athletic exercises are open at 
all seasons of the year. .V large number of val- 
uable scholarships and prizes are awarded an- 
nually. 

Mv next visit was made to the T.ondon Hospital 
and Medical School. I'nivcrsity of London, which 
is located in East London, on Whitechapel and 
Mile End roads, a densely crowded section of 
ilie cit\-. I s]ient some three hours in this insti- 
tiition. Through the courtesy of the Warden 1 
was given i)ermission to go through the medical 
college buildings and through the hospital adja- 
cent thereto. The college buildings are large an<l 
handsome structures, adiuirably adapted to the 
work of instruction. 1 was introduced to Dr. W. 
i'lullock, jirofessor of bacteriology and pathologi- 
cal histology, who courteously gave me an oppor- 
tunity to see his laboratory and the character of 
his work. 1 le has a well-org"anize<l department, 
and is doing most excellent teaching, judging 
from his e(iuipment and environment. The mus- 
eum connected with the college is the largest an<l 
most complete 1 have every seen. The Loiulou 
Medical .School has a large faculty, and an able 
corps of lecturers and demonstrators. Man\' of 
the hest-known surgeons and ])h)sicians in Lon- 
don are comiected with this scIkioI. .Sir Jonathan 
llutchinson ;ni(! Sir '.•'rederick' Treves. JJart., are 
emeritus jirofe^sors of surgery, bm give a course 
of lect^u■e^ in clinical surger\- diu'ing the winter 
>eason. 

This college lias <jver 300 medical stuilents in 
attendance u])on its ditferent courses of instruc- 



tion. To become a ftilly i|Ualifie<l medical ]/rac- 
titioner in (jreat llritain the student nui>t pass 
( 1 ) a preliminary e.xainination ; ( _' ) he must 
stud\- at a medical school for five years: (3) he 
must pass a (|ualifying examination in medicine, 
surgerv and midwifery. Students wishing to 
graduate at the L'niversity of London must pass 
the matriculation examination of that universit}'. 
The next ste]) after passing the preliminary ex- 
amination is to enter a medical scIkjoI an<l register 
as a medical student at the office of the (leneral 
-Medical Council. His name is then enrolled upon 
the students' register. .\ perpetual fee of 1 Jo 
guineas, if ])aid in one sum, or 130 if ])aid in in- 
stallments, at commencement of first, second and 
third years (equivalent in our money to some 
^560) is requirc<l. The scheme of curriculum is 
as follows : 

I'irst Year — lliology, chemistry and physics, 
elementary anatomy and physiolog\'. materia 
niedica and practical pharmacy. 

Second Year — .\natomy and pliysiology and 
histology, lectures and demonstrations. Tutorial 
classes for the examinations. 

Third Year — Anatomy, physiology and histol- 
ogy. Lectures on midwifery, pathology, pharma- 
cology and thera]xnitics. Hospital medical and 
surgical practice. 

Fourth Year — Hospital medical, surgical and 
gynecological practice. Attendance on maternity 
cases. Lectures and demonstrations on medicine, 
surgery, pathology, morbid anatonn- and pulilic 
health. 

Fifth ^'ear — Hacteriology and pathological his- 
tology, operative surgery, anesthetics, obstetric 
operations, .\ttendance at a fever hospital, a 
lunatic a.sylum and a vaccination station and the 
special departments. Tutorial classes for the 
final e.xaminati(5ns. 

-V candidate for the diploma of the L'oPijoint 
rioard, M.R.C.S., L.R.C.P., should pass the first 
examination in chemistr)-, physics and Ijiologv 
and pharmacy during the first year. .\t the end 
of the third w inter session he should ])ass the sec- 
ond examination in anatomy and jihysiology. and 
at the end of the fifth year the final cxanu'nation 
iri medicine, surgery and midwifery. A sonievi hat 
similar course must be followed b\- camlidates 
seeking degrees and iither diplomas. 

The London Hos])ital is a very large au'! im- 
posing structure, with courts, gardens and de- 
tached buildings, co\'ering some i^ to _'o ;icres 



120 



THE HOSPITAL BULLETIN 



of ground. It presents a vast field for elinical 
study. The number of in-patients treated in 190:; 
was 14,990. and out-patients 238,691 ; oi^erations 
under anesthesia. \jX\t,i). 

Whilst the equipment of the liospital is up to 
date, I saw nothing thfferent from what we have 
in the L'niversity ilosjiital in I'.allimore. Tlie 
operating-rooms and wards are more numerous. 
Init no better than ours. I saw only one surgical 
operation, and this took up so much of m\ time 
that I was not able to remain to see the second. 
1 take it that siu-gical work is about the same in 
iuirope as in .\merica. Our results here are as 
good as theirs. 

J regret that I was not able to visit St. 'I'luimas". 
Ouy's, St. I'.artholoniew's and other hospitals in 
J.ondon. 'I'he object of my visit was rest and 
])leasure. and not a tour of medical in.s]-)ectiou. 
I TO I'.i-; t'o.\'Ti.\i'i';L). I 



SEE .\AIERICA EIRST. 



By Randolph ll'iiisld'ic. 



1. I-'ko.\i I'.ai, 11 moki-: •i<i Eos i\.xc;i-:i,i-:s. 
The above caption has I)econie a popular slogan. 
and we see it re])eated in the newspapers and em- 
blazoned on billboards along many of the railway 
lines of the country. It is a truism only in a re- 
stricted sense, as it depends upon what we wish 
10 see as to whether we should sec America first 
or not. First or last, however. 'one shoidd see 
his own cotmtry, and it is a great satisfaction to 
the writer that, tliwugh he was not able to see 
America first, he has beon able to traverse a large 
portion of our counlr\- during the ])asl few years. 
The ojiportunities for distant travel, and the ease 
and coiufort in accomplishing long journeys, as- 
sociated with a cost that is not excessive, enablo 
one to satisfy a craving which amounts almost to 
a passion with many of us. The annual meetings 
of the American Medical .\ssociation occiu'ring 
now on the .\.llantic and then on the Pacific 
Coast, or alternating ])erha])s between the (Ireat 
Lakes and the (iulf, offer one the opportunity to 
.see tile country, as well as to keep in touch with 
medical thonghl and activit}'. 1 earnestly com- 
mend to my younger iirofessional brethren the 
many pleasures and advantages incident to at- 
tendance on tjie annual meetings of the great 
.\nierican Medical Association. I'his year the 
anmia! gathering occurred at Los .\nceles, Cal.. 



irom June 2b-2,o. It is a long step from Baltimore 
to Los Angcle.s — about 3000 miles — which can 
he made by fast train in from four to five davs, or, 
by fast walking, as in the case of Edward Payson 
Weston, in about 70 days. Xot being good on the 
walk, \-our corres])ondent took a fast train. It 
is said that the longest wa_\- round is the shortest 
way home : certainly the route taken by the special 
train upon which we embarked was sufficiently 
circuitous. I left home on June 19 bv the Penn- 
sylvania for New \'ork, passing through the tube 
under the Hudson River into the beautiful new 
marble station in the midst of the city. Our 
special train, with stateroom coaches, club and 
dining cars, electrically lighted and cooled by elec- 
tric fans, left from the Grand Central Station, 
and after a beautiful moonlight trip up the Hud- 
son, reached Albany about lO o'clock, where sev- 
eral prominent jihysicians and their wives joined 
US, including our nwu alumnus, I'rof. Win. T, 
Councilman of Harvard ]\Iedical School. Thence 
tlirough r.uft'alo and northern New York in the 
night, reaching the shore of Lake Erie in the early 
r,K)rning, and Cleveland, which has passed Balti- 
more in population according to the last census, 
soon thereafter. I-'rom Cleveland to Indianapolis, 
and thence to St, Louis, where we arrived in the 
evening, in a little over 24 hours from New York, 
Parenthetically, I may say that the most unpleas- 
ant part of our long transcontinental journey was 
experienced in passing through Illinois on June 
20. At St. Loifis we \\-ere joined by Drs. Franklin 
!1. .^niith and Thomas P>. Johnson of Frederick, 
Aid., who completed our company of 109 persons, 
.Missouri -was traversed in the night, and the 
second morning out found us at Kansas City, at 
breakfast time. Through the rolling prairies of 
Kansas, with wheat and corn fields extending to 
the horizon, and with but sparse foliage, we passed 
ia])idly. \\'e were in one of the great agricultural 
States, and the neat farmhouses and huge red 
I'.arns attested the thrift and prosperity of the 
farmers. As the western ])art of the State was 
reached the country ajjpeared less fertile, the 
I'lains were uuculti\'ale(l, an<l great droves of 
horses and cattle were seen. Night cwertook us, 
and we ran through the southern part of Colorado 
in the dark. < )n the morning of the third day we 
were in New .Mexico, on the Sant'e Fe trail. De- 
scending from t!ie more elevated parts of Colorado 
we reach the high ])lains of New Mexico, and 
])ass thniugh ;i country that has had a histori- 



'I'llE HOSPITAL BULLETIN 



127 




i;i.i:nw<miI) misshix inx, iuvkhsidk. cal. 



cal past, for iicrc were settlements and coniiminal 
towns before Columbus discovered the Western 
world, and here the con(|uerino- Spaniard carried 
the sword and the cross as early as 1539. New 
Mexico as seen from the train is a dry, almost 
flesert land, liot in the daytime, but cool and 
I'leasant at nijjht. On the horizon, and often nea.' 
at hand, are almost bare mountains showing pur- 
ple in the distance, whilst the plains are covered 
with a scant growth of sage bush, cacti and coarse 
grass. There arc deeply excavated water courses, 
often dr}' or containing only a tiny stream, but 
wherever water is found in sufficient quantities 
to be used for irrigating the arid soil, large crops 
of grain, alfalfa and other products are raised. 
Human habitations are few and far between, and 
consist for the most part of low adobe houses, in- 



habited by Mexicans, with here and there ])ueblos, 
or communal houses, of several stories, housing 
at times large villages of Indians. New Mexico, 
however, is at the parting of the wa)s, and new 
ideas and new conditions are crowding out the 
old, though at present both exist, side by side. 
Thus along the railroads flourishing towns, even 
reaching to the dignity of modern cities, are 
found here and there, as Las \'egas, with 8000 
l)opulation, and Albuc|uerque, which is a much 
larger place. At all important places there are 
beautiful and commodious railway stations and 
l.'otels, at which the weary wayfarer may disem- 
bark and find good cheer and rest. Indeed, all 
trains stop sufficiently long to enable travelers to 
get their meals in comfort. The main line of the 
railroad does not go to Sante Fe, though it 




MAGNOLIA AVEXri;. I! 1 VEltSII (E, CAI.. 



128 



THE HOSPITAL BULLETIN 



passes within a few miles of that city, hence I 
(lid not have the opportunity of visiting- it. At 
the stations along- the line Indians llock to the 
train to sell their wares to the voyager. The 
nohle red n-ian. inchuling his wife, is hv no mean!* 
a very attractive ohject, though apjiearing pic- 
turesque at a distance. He appreciates his own 
value, and will not permit himself to he kodaked 
until he gets a quid pro quo in the shape of a coin. 
The women seem to value silver coins chieflv as 
ornaments to be attached to their leg^ins. At 
Albuquercjue the railroad crosses the Rio 
(jrande on a long bridge, the river being a siial- 
low, insignificant stream. Xot far from Al- 
Iniquerque is the Indian village Laguna, which is 
a pueblo situated on a high rock and conimanding 
an extensive view of the surrounding plain. Sev- 
eral hundred Indians live at this pueblo, whicii 
consists of houses three stories in height, the up- 
per .stories being reached by long ladders. These 
liouses are built around a plaza or square, where 
(lances and other cerenicjnies are held, and where 
we had a ceremonial dance given in our honor 
in exchange for a few coins. The dance w as not 
interesting, and in the future I would prefer giv- 
ing a coin not to see it. rather than to witness its 
])erforn-iance. The houses were scrupulously 
clean, and usually contained a bed, iron cooking- 
stove and a few sin-i])le articles of furniture. This 
pueblo has been in existence for centuries, and was 
doubtless located at this point on account of its 
(iefensibilitx-. The younger Indians are being 
educated, and adopt civilized dress in many in- 
.stances, while the older ones continue to wear the 



characteristic garb of their race. .\t this i)oint 
we were deluged with a sudden and torrential rain, 
the only time we had to seek shelter during our 
journey until we were leaving Colorado Springs 
upon our return. We were unable to visit souie 
])etrified trees on account of this rain. Continu- 
ing through New .Mexico, we passed into Arizona 
in the evening, and n-iuch to our surprise found it 
necessary to draw our blankets over us at night, 
and were too cool at that.' We had a>cended 
several thousand feet in the night, and had come 
into a different climate. .\ 5 o'clock on the morn- 
ing of June 23 we reached the (irand Canxon of 
.\rizona. This is one of the world's wonders, and 
is unique. It is an immense chasm in the face ot 
the earth. 217 miles in length. i_^ miles in width. 
o|)posite the I£l Tovar Hotel, and 6000 feet in 
dejnli. and through its floor flows the Colorado 
River, which has ap])aremly caused the cha>m hy 
crosion. The walls of the canyon are almost 
vertical for several thousand feet, and there arc 
but few places at which a descent can ]k- made. 
Within the canyon are fantastic mountains and 
dee]) valleys and fissures of varying colors — white, 
gra\-, yellow, brownish red and black — which, coni- 
l)ining- with the green of the valleys ami the hluisli 
or purplish haze which overspreads the ?cene. 
especially as the sun comes over the crest of the 
mountains, and the silver thread of the river at 
the bottom of the cleft seven miles a\vav, fcirm a 
vista that will remain indelibly impressed upon 
the memor\- as long as life and reason last. It is 
impossible to find words to describe liie canyon. 
It is rightly called grand; it is kaleidosc(->pic : it is 




cii;.\.\i.i; i,i;i.\i;. i;i \ i:i;siim:. i ai,. 



THE IIOSPITAT, BULLETIN 



129 



fantastic, grotesque, grim, appalling and beautiful. 
We spent 30 linnrs at the Grand Canyon, and on 
the morning of our departure seven or eight long 
special trains from Chicago rolled in, filled with 
doctors and their families, amongst whom wero 
Drs. Hiram Woods, James J. Carroll, W'm. 11. 
Welch an<l others from I'laltimore. This sudden 
intlu.x of visitors almost swamped the hotel, and 
we were very fortunate to have been on the spot 
before the great crowd arrived. Leaving the 
canxiin on June 24. we rajjidly descended imtil we 
>truck the main line at Williams, where we re- 
>nmed our journev to the west. The town of 
Winslow, in .\rizona. appears to be quite a thriv- 
ing place. I tried to learn for whom the town was 
named. 1nu without success. The onh' answer I 



groves and beautiful Howers. Soon our train 
ptdled up at Redlands, where we were met by 
])hysicians and citizens, who presented us with 
luscious fruit. We here enjoyed a ride through 
the city and up to Smile)- Heights. Twenty years 
ago Redlands was a barren waste ; now it is a.s 
a garden of the Lord for beauty. About that time 
Albert K. Smiley, a fellow-aUnnnus of mine of 
I laverford College, whom I know, bought a tract 
of land at this point, introduced water and con- 
verted what had been a desert into orange groves 
and parks. The homes here and elsewhere in 
.Southern California are low bungalows, covered 
with beautiful boganvilla vines and other flowers, 
and surrounded by well-kept lawns, with palms, 
cacti, pepper trees, eucalyptus, acacia and other 




THE intANri CAXVOX, ARIZONA. 



icceived to my inquiry was that it was named 
;:fter some old man named Winslow. The route 
\\estward descended ra])itlh', and we continued to 
traverse a dry and ])arehed country until we 
)"cached the Colorado River at the needles, and 
iq)on crossing the river we were in California, 
riie town of Needles is said to be the liottest ])lacc 
in tlie United States, and shortly before our arrival 
the thermometer registered 117 degrees in the 
-hade. It was not tnipleasantly hot at the time 
'li iiur >top, about 6.30 P. M. \\'e were beset by 
a lot of dirly .Mojave Indians, barefooted and un- 
\'. a>lK'd. who ottered bead necklaces and other 
worthless jimcracks for sale. Still traversing a 
barren country, we continued toward Ltis .\u- 
ueles. Early in the the morning of June 25 we 
rcaclKHl the fertile and highly cultivated San 
.'ernarilino \ alle\'. with its teemnig orange 



foliage semi-tropical in character, and unknown to 
us in the East. Roses, geraniums and other 
llowers grow in profusion, and in summer and 
winter alike add a blaze of color to the scene. The 
air is dry and bracing, and though it may be hot 
in the middle of the day, the evenings are cool and 
jdeasant Rain falls during two months of the 
vear. and during the other 10 months one does 
not have to carry an umljrella. The chief objec- 
tion to the climate is the fact that no rain falls, 
and the countr)- is almost shoe deep in dust. Our 
next stop was at Riverside, where we \vere again 
met and welcomed by the citizens and our sections 
on the train filled with beautiful frui*:. We here 
had lunch and dinnei" at the Clenwood Mission 
Inn, a really remarkable hostelry, with its chiiue 
of bells, wonderful organ, pictiu-c gallery and 
manv curios, to sa\' nothing of the beautiful 



130 



THE HOSPITAL BULLETIN 



luildiiiij and excellent fare and service. We were 
taken in automobiles on a 17-niile drive through 
orange groves that extended as far as vision 
reached. At this place also was a botanical gar- 
den containing many rare plants and trees, and a 
collection of cacti of all varieties, perhaps 150 in 
number. Palms of many varieties were also seen 
lining the avenues and drives of the city and 
coimtry. We were in the heart of the citrus sec- 
tion of California, and from this region most of 
the oranges are shipjx'd. Leaving Riverside aliout 
6 o'clock, we reached Los Angeles at 9.30. and 
our journey across the continent had been cnm- 
pleted. 

[to i'.i-: c-(jxtinl'1-:i). | 



GAS GANGRENE, WITH A REPORT OF 
TWO CASES.* 



r.y C. W. RoJiicKT.s. M.D.. 
Douglas, Ga. 

Aiv interest in this formidable complicalion ijf 
surgical practice has recently been aroused by its 
occurrence in two cases in my service at the Doug- 
las Hospital. I have therefore selected the sub- 
ject which has just been announced in your hear- 
ing primarily because of the occurrence of these, 
and, secondly, to illustrate in a very impressive 
way, the fact th.at. although we may be im the 
alert for this complication, it will occasionally 
baftle our efforts at propliylaxis, and before we are 
aware produce disastrous results in a case which 
at first would be looked upon as likely to recover. 

As one reviews the subject of emphysematous 
gangrene, spoken of in surgical literature under a 
voluminous nomenclature, a few striking facts 
impress themselves upon us, rendering the subject 
one of sufficient importance to justify its brief dis- 
cussion before this society. .Mtliough it is claimed 
by some writers that gas gangrene is oi rare oc- 
currence, a study of the subject would rather in- 
cline us to the belief that it is more frequently met 
with than one would sup])Osc. The high death 
rate ])roduced b\- this infection and the fretpiency 
with which the condition is overlooked make it 
necessary that the practitioner be always on the 
lookout if lie is to be indeed a jirotector of the 
lives and safet_\- of his clientele. It is not my pur- 
pose to discuss at length the symptoms, pathology 



•Koart at tho lucetin;; of tin' Klovcntli District Mt'dical 
Association, Kastinaii, Ga., .Iuin' 'JO. lOH. 



and diagnosis of this dreadful malady, because 
your textbooks furnish this information in a more 
satisfactory manner. But instead I want to give 
you the facts connected witli the cases referred to 
in the outset and tiy to impress upon you the im- 
portant ])oints. such facts as will enable you to 
correctly diagnose the trouble when it appears 
before it is too late for surgical interference. I 
have referred to the subject of this paper as a 
complication, not wishing to convey thereby the 
idea that all cases of gas gangrene are secondary 
to some injury, but because the great majority are 
seen to develojj after crushing injuries or acci- 
dents in which the soft ]iarts are disorganized and 
contaminated with tlirt. In 1891 Dr. A\'elch of 
the Johns Hopkins Hospital discovered the bacil- 
lus which is now conceiled to be the cause of most 
cases of gas bacillus infection, although there are 
a few other organisms capable of producing gas 
in the tissues with practically the same symptoms. 
To this organism he gave the name Bacillus 
aerogencs capsulatus, thereby describing it prettv 
fully as a bacillus with a capsule that grew best 
without oxygen. This bacillus is found most 
often in the intestinal tract of mammals and in the 
soil, pai'ticularly the soil of streets, public high- 
ways, railroads, etc. It has. however, been 
recovered from \ arious other sources, demon- 
strating the fact that the infection may come in 
a variety of wa}s. For the purpose of this paper 
r shall assume that we are dealing with the mal- 
ady as it most often appears, that is, as a compli- 
cation of an injury that has been contaminated 
with soil from streets, iiublic or railroads. As I 
have intimated, it is in this class of injuries that 
nearlv all fatal cases of gas bacillus infection arj 
seen, and before proceeding to the report of cases 
it might be of some interest to the members of this 
as.sociation to give here in passing a rather de- 
tailed history of the events leading up to the case 
T wish later to report in order that you may appre- 
ciate more fully the facts I shall mention in its 
coimection especially pertaining to the prophy- 
la.xis employed and the immediate after-care in- 
stituted. 

In .March of this \ear a \-oung lady of about 
18 was admitted to the Douglas Hospital sufTer- 
ing fnnn the effects of a gunshot wound of the left 
axillary region. Cpon admittance 36 hours after 
the injury the patient was found in the following 
condition : .\ large wound occupying the whole 



TlIK HOSPITAL LIULLLTIX 



'3t 



of the left armpit, severing- the axillary artery and 
the inner trunk of theliraehial plexns.contaminate'l 
1)\- dirt and soiled clothint;-. was found. The pa- 
tient was very pale from loss of l)lood, the ])ulse 
rapid, cx]jression hat^ijard, temperature ioi°. The 
injured arm was warm and had a gooil color, 
although there was considerahle swelling. The 
hand and lower forearm was insensihle to touch. 
The next day after admittance patient complained 
of severe pain in the arm, but pulse was stronger, 
slower and aj^pearance of arm was ahout the 
same. ( )n dressing- tlie axillary wound I note;l 
a reddish water discharge of a peculiar odor, and 
around the liorder of the wound a bleb-like for- 
mation was present. In one of the largest of these 
blebs a dark fluid could be seen, showing through 
the thin wall, which, on puncture, proved to be of 
the same character as that oozing fronj the wouml. 
The next day the nurse noticed early in the morn- 
ing that the hand and arm were more swollen, 
there was more complaint of i)ain, and a distinct 
discoloration of the hand and arm, ])ro(lucing- a 
rather marbled appearance, had begun, with areas 
here and there of reddish green, giving the arm 
the appearance of ecchymoses. ( )n tlressing the 
wound several large blisters were present arotmd 
the border and about the arm, all containing 
syrupv fluid of the same a])]jearance and odor as 
that con-iing- from the wound proper. At the san-ie 
time gas was discovered in the tissues about the 
wound, on the chest wall and down to the elbow 
on the arm. On pressure it escaped from the 
wound. The diagnosis was no longer in doubt, 
and I discovered to n-iy cha,grin that in an over- 
zealous efifort to save an extremity, a desire made 
more keen by a solicitous father, that I was face 
to face with a severe case of en-ii)hysematous gan- 
grene. Systemic syn-iptoms rapidly ensued, tem- 
perature and pulse went up, patient became de- 
lirious, and death ended the scene after some 36 
hours' suffering. Preparation for amputation was 
made at a very late hour, but when the patient 
was anesthetized it was discovered that the con- 
dition involved a large area of the chest wall, and 
amputation could not be done through sound tis- 
sues. This deterred us from further effort, and 
we relin(|uishc<l hope, I trust, wiser, but deejily 
convicted of unintentional oversight and n-iisjudg- 
ment. 

On the heels of this case, and having read care- 
fully and repeate<lly the literature on the subject. 



the second case 1 wish t(j report, pertaining di- 
rectly to railroad surgery, came in for treatment. 
1 ie was a young negro man of about 22 years of 
age, well develo])ed and apparently in sjilendid 
health. In attempting- to sto]) a car of lumber o]i 
which he was riding, the car having- been shoved 
forcibly on to the main line from a switch, in an 
attenipt to connect it on to the train control was 
lost and the car struck with considerable force 
another car of lumber, throwing the ne.gro be- 
tween the cars and piling quite a (juantitv of lum- 
ber upon him. He was extracted and found in 
apparent good condition save one leg. When he 
arrive<l at the hospital he was in splendid condi- 
tion — no shock, verv little loss of blood, good, 
strong- pulse, etc. Examination showed that he 
had suft'ered a compound fracture of the tibia and 
fibula of the right leg, with considerable pulpifica- 
tion of the tissues and laceration of the skin just 
liclow the knee. The wound was contaminated by 
dirt, greasy bits of pants and underwear, and I 
noted at the tin-ie considerable crackling in the tis- 
sues, which I took, of course, to be air that had 
gotten into the wound. Recognizing this case to 
be one in which gas gangrene readily develops, 
and with the experience in connection with the 
case just reported clearly in n-iind, the patient was 
anesthetized, the wound laid open, a very thor- 
ough cleaning done, in which green soap, bichlo- 
ride and hydrogen peroxide were freely used, 
the bones approxin-iated, free drainage through 
numerous wounds in the surrounding skin estab- 
lished, a few stitches bringing- the skin together in 
places introduced, and a [blaster cast applied, im- 
mol)ilizing the extremit}-. A large window was 
cut in the cast at this time, allowing frequent 
inspection and dressing of the wound. I remem- 
ber to have remarked to an onlooker and the 
assisting physicians that this case was a good one 
for the development of gas gangrene, but in real- 
ity I least expected that it was going to develop. 
The patient was put to bed in good condition. 
Circulation in the foot good. The next morning- 
he complained of pain in the leg. The foot was 
a little swollen, but warn-i and of good color. Tem- 
jjerature w-as 101°, jjulse bounding and a little 
rapid. The dressing was removed, when a rather 
uncharacteristic fluid was noted escaping from the 
wound — taken to be an excess of fluid left in the 
wound in the cleaning-up process. No crepitation 
could be detected more than was present at the 



Til II HOSPITAL BULLETIN 



time of admittance, although this was again noted. 
The next morning patient complained of a rest- 
less night, severe pain in the leg: temperature was 
103° and pulse 140. Foot was rather cool, badly 
swollen, and nails purple. The cast was immedi- 
ately split its entire length and left for a short 
while. The foot not only remained cool, but got 
worse, and when the dressings were removed a 
little later a sweetish, bloody discharge was noted, 
a few blebs were seen about the wound and crepi- 
tation well difTused. The cast was removed, when 
it was found that the emphysema extended almost 
to the ankle. Preparation for amputation was 
made as hurriedly as possible, but before this 
could be done patient was in a stupor, had a tcm- 
])crature of 104' 2° and a pulse of if)0. b'ifty-two 
hours after admittance leg was amputated in the 
mitldle of the thigh, but jiatient's conditinn was 
not changed b_\- the operation, although he re- 
gained consciousness perfectlv and rallied from 
the shock of the operation. The night following 
he died, the symptoms of a severe toxemia ending 
the scene. 

Now. I lia\'c presented the histories of these 
cases that you may see the similarity, and have 
given my conduct of them in the ho])e that you 
will freely criticise where criticism is due, trusting 
thereby that some plan of management in such 
cases may be found that will result in a more 
favorable outcome. 

I'rom a stud\- of the cases reported and the lit- 
erature of the suljject a few practical conclusions 
may be drawn : 

T. This disease develops most often in wounds 
contaminated by street dirt, railroad dirt and in- 
testinal-tract discharges. 

2. Laborers and railroad men are prone to the 
infection due to their ex])osure to the above-nien- 
tidued sources of contamination of their wounds. 

3. Although it would appear that many cases 
are infected with P>acillus aerogenes capsulatus 
organism, in which the tissues successfully com- 
bat its further development, the disease makes its 
appearance clinically in relatively few cases — say 
I in USD surgical cases exposed to the infection. 

4. .\11 wnunds contaminated with street or 
railway dirt should be watched for the develop- 
ment of this infection for 48 hours at least before 
ser.iing them up with dressings or plaster casts. 

5. -Mthough it a])pears that the organism re- 
sists the ordinary antiseptics, such as bichloride. 



hydrogen peroxide, tincture of iodine and green 
soap, these having been freely and faithfully used 
in case 2 reported of my cases, and in various 
other instances in tlie literature, these agents 
should be vigorously used, especially hvdrogeu 
])eroxide, and then the wounds left open so that 
plenty of air may come in contact with them all 
the time. 

6. \\'hen the cinnplication has developed, as 
would be determined by a definite, clean-cut clin- 
ical picture, tlie onh- treatment that one should 
consider is early amputation through sound struc- 
tures, when this procedure will remove the in- 
fected tissues. If amputation cannot be done as in 
involvement of the body, proper multiple incisions, 
with irrigation with Intlmgen ])cro.xide, should be 
resorted to. 

7. Treatment to Ijc of avail must lie clone lie- 
fore J 2 hour- has elapsed fiilk)wing the injurv. 



Dr. .\. W. ( liami)ietro, class of njoj. writes as 
follows : "Yours of recent date has been received, 
and relating to the contribution for the Univer- 
s'it}-, I am glad to sa\- that I had long ago thought 
01. and I have been watching with earnestness, the 
l)rogress of the endowment fund. To send you 
now a small contribution, is against my determina- 
tion, but I have decided to contribute a good sum 
as soon as my affairs have been straightened out. 
1 liave been successful in two chemical inventions 
of highl\- commercial value, and am dealing" witii 
a large concern for the selling of jjatent rights. 
The iirst income I will have, either in money or 
preferred stock. I will be ver_\' glad to contribute 
a good deal toward this worthy cause. Moping to 
hear that you have been successful in raising the 
balance of the fund. 1 assure you again of my 
])rumise." 



A\'e are gUul Ui report that Uishoi) Ltither Wil- 
son. Al.D., class of 1877, who was seriously ill in 
Londeni, is much imi)roveil, and will be able to 
attend the coming conference of the Methodist 
Church in America. 



Dr. J. llurr Piggott, class of 
superintendent of the L'niversit>' 
now located in Grafti;)n. \\'. \'a., 
visitor to Baltimore. 



1007, former 
1 [osjiital and 
was a recent 



Till': llOSi'lTAL BULLETIN 



i3o 



THE HOSPITAL BULLETIN 

A Montlily Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



1!al] iMORii, Septemijer 15, 191 1. 



ixi\ I■.l^'S^^^• oi. marn i.axd's kI'Xorix 



IIk- liiiK' (.■xaniiiiation for licensure of the 
Maryland State ilnard of Medical Examiners is 
iinw a niatl'er of history. 'I'he results have heeu 
announced, and it heliooves us as one of the insti- 
tution^ \'itally interested to carefully ins])ect the 
outcome as rcLjards the part played hy our men. 
sii tliai in the future we may fortifv ourselves in 
the Weak places and thus lietter our record. W'c 
are iiniud i'^ annoiuice to friends and alumni that 
of 35 men standing- the examination hut three 
failed til measure U]) to the standard of excellence 
neci.^s>ary tn the ijrivilci^e of i)racticing- medicine 
in .Maryland. i^iviuL;' us the very commendable 
rec^ri! (if hut S.57 per cent, of failures. One of 
tile •ucn wild failed was a member of the class of 
11)05. which 1irini;s us to the point nf attain m'i^iuL;' 
till r-e w hn conteni])late a])pearin<;' before the 
lioard to do so as early as jiossihle after gradua- 
tiiin. as each year thereafter renders a successful 
outcome less likely. Tliere were 26 members of 
llie class of 11)1 I before the Hoard, witli one fail- 
iu\-. ni- ,^^40 ])cr cent.; three men nf 1010, one of 
wliiim failed: four men of iipo. all successful, 
and one candidate, class (if 11)04. ^^'i" passed. 

.\s ilatleriiiL;- as the al)ove result is, we wisli tn 
assure our alumni and friends that the authorities 
of the medical department of tiie L'niversity of 
Maryland will in iin wise lessen their \-io-ilance 
with regard to the manner of men u])cin whom 
they CKiifer their di])loma, and will strive in the 
luiurc tn wipe out the mortality entirelv. 

li alMi gives us unbounded ])leasure to an- 
nounce that one of our men. with an average of 
<)i. -liares the honor of leading- the Slate L'oard : 



another, with an average of (jo, was within close 
hailing distance, and, taken as an entiret\, the 
grade of all our men was decidedly above the gen- 
eral average of former years. On the whole, we 
may all take pardonable pride in the outcome, 
'idle L'niversity of .Maryland is willing to lie 
judged b_\- tile standard — "Hy their fruits shall 
thev be known." 



LET US ADD YOUR XA.Mh'.. 



We have had a summer of unusual heat ami 
(Hscomfort. We have been threatened with .1 
water famine, and the water we have been fur- 
nished by the Uity Water Deiiartment has not 
been fit to wash in. and has not l^een such that 
one would willingly of¥er to a decent dog to drink. 
.Mmost everyone who has been a1)le to get out of 
the city has gone to more congenial scenes. At 
the best, the dog da\s are not favorable times for 
getting contributions t<i an endowment fund. We 
have therefore no large additions to rei)cirt, but 
are thankful that we can note a substantial in- 
crease during the month. 

The subscriptions to September 1 are as fol- 
li )\vs : 

Robinson bequest S5000 

Dr. Hugh Hampton Young, J. H. L' too 

Dr. S. J. Meltzer, LL.D., Xew York 10 

Dr, Gideon Timberlakc 25 

Mr. n. P. Ohm 10 

Dr. Samuel W. Moore, D.D.S 25 

Thomas C. Basshor Company lo 

Hospital Bulletin 5 

Maryland ]\[edical Journal 5 

Miss C. M, Selfe 5 

Prof. R. Dorsey Coale, Ph.D 100 

Dr. John J. R. Krozer, 1848 50 

Dr. Eugene F. Cordell, 1868 10 

Dr. Joseph T. Smith. 1872 10 

Dr. W. J. Young. 1872 2^ 

Dr. Thomas A. Ashby, 1S73 100 

Dr. David W. Bulluck, 1873 100 

Dr. Robert Gerstell, 1873 5 

Dr. Randolph Winslow, 1873 100 

Dr. H. T. Harrison, 1874 3 

Dr. John D. Eiske, 1875 5 

Dr. Charles W . Mitchell, 1881 too 

I )r. L. Ernest Xeale, 1881 100 

Dr. J. M. Hundley, 1882 250 

Dr, Henry Chandlee, 1882 10 

Dr, J. C. Perry, 1885 100 



134 THE HOSPITAL BULLETIN 

Dr. B. ]\IerrilI Hopkinson, 1885 25 deavor to measure up to the liigh standard you 

Dr. H. C. Reamer, 1885 10 predict for me as Ions;- as I am a member of the 

Dr. Frank I\Iartin, 1886 100 School Board of Bahimore City. 

Dr. C. W. McElfresh, 1889 100 "I desire to state that The Bulletin is the 

Dr. Saint Clair Spruill, 1890 100 most thoroughly read and enjoyed of any journal 

Dr. Rupert Blue, 1892 100 I take. It not only keeps me in touch with my 

Dr. Frank J. Kirby, 1892 50 frienils among the alumni, but also keeps me in- 

Dr. Harry Adler, 1895 100 formed about the splendid work being done at 

Dr. Jose L. Hirsh, 1895 5" ^'^^ Hospital and University, of which every lovcd 

Dr. Joseph W. Holland, 1896 50 Mar\Iander will feel i^roud." 

Dr. R. W. Sturgis, 1896 2 

Dr. INIartin J. Cromwell, 1894 50 Dr. Samuel William Hammond, class of 1905. 

Dr. Page Edmunds, 1898 50 of LaniiK>rt's Point, .Norfolk. \ a., writes as fol- 

Dr. L. W. Armstrong. 1900 10 lows : 

Dr. S. Demarco, 1900 50 "Referring to editorial department of thi- 

Dr. ]\I. S. Pearre, 1900 5 month's Btllktix ( August number), that new 

Dr. J. D. Reeder, 1901 50 requirement of the New York Board of Regents 

Dr. Nathan \^'inslow, 1901 50 comes as a surprise just at this time. Allow me 

Dr. .\rthur M. Shipley, 1902 250 to say that your numerous requests for contribu- 

Dr. H. C. Davis, 1902 10 tions to the endowment fund have been timely. 

Dr. H. L. Rudolf, 1902 25 We'll have to get busy : no (juestion about that. 

Dr. Hugh Brent, 1903 25 Reminds me of the story of the rabbit that climbed 

Dr. G. C. Lockard, 1903 25 the tree — briefly told. The boy acknowledged 

Dr. Geo. S. M. Kiefi'er, 1903 25 that 'rabbits could not climb trees." but in this 

Dr. H. J. Maldeis, 1903 25 i)articular instance he did "because he had to or 

Dr. R. C. Metzel, 1904 10 the dog would have caught him." 

Dr. Robert P. Bay, 1905 100 "'It appears that the time has come when the 

Dr. Jos. A. Devlin, 1906 10 medical department of the University of Mary- 

Dr. \V. F. Sowers, 1906 25 land has just .got to have a big endowment fund. 

Dr. Frank S. Lynn, 1907 25 The merits of the claims for assistance of the old 

Dr. T. H. Legg, 1907 5 University I ( )h, that the people with money 

Dr. E; H. Kloman, 1910 25 cotild only know I I notice some good responses. 

but many others are yet unheard from. When 

Total $7802 the facts and circtunstances are put square up to 

.\dditions for the mnnth S265. the legislators of good old Maryland, iiow can 

. they turn it down ? Think what the University 

^ of ^laryland has been to the State — verily a 'fos- 
tering mother.' But. in the name of justice and 

Dr. Howard J. Maldeis. class of i<)03. is home righteousness, the State should aid. and it is be- 

from a trip to the North. lieved that the members of the Legislature wilt 

see the necessity in this einergenc\- and do their 

The editor of Tijf. Bl-lletix has been favored <'"ty. There are enou.gh University (if .Maryland 

with the following letter from Dr. Albert Tyler doctors in Maryland to elect or defeat candidates 

Chambers, class of 1898, who was recently ap- "'' niembers of the Legislature for re-election if 

pointed to the School P.oard of Baltimore City : they will organize and work to that end." 

"Until I have the opportunity to thank you in ^^'^-^ 'lope that tlie facts will l)e i)ut "s!|uare up 

person, please accept my profound appreciation of '" f'!"-' Legislature" this coming .session. 

your kind notice about me in The Hospit.\l 

BuLLETi.v of July 15, 191 1. It was especiall}' Dr. Kandolph Winslow is in receipt of the fol- 

gratifying to see this at a time when 1 was under lowing letter from \)y. Joseph .Kngelo Devlin, 

fire from certain quarters and having my motives class of 1906, 168 West 87th street. Xew York: 

seriously misrepresented. I shall certainly en- '"I hasten to add a drop in the Iwicket : [lerhaps 



THE JrlOSPITAL BULLETIN 



135 



later I can add a little more. Anyway, I wish 
you all success in your endeavor for so worthy a 
project as the Pathological Department I'jidow- 
nient I'\md. 1 have just returned from Texas; 
went on a three-weeks' vacation via the Alallory 
Line to (ialveston, and the first vacation I have 
had in three years. My slight visits to hospitals 
in Galveston and 1 louston make me helieve that 
courses in hos]3ital management shcndd be a part 
of the curriculum. 1 'erha]js Dr. Corclell could 
set his clock hack a quarter of an hour and let 
someone give a few minutes' dissertation on "The 
futility of sweeping dirt from the center of a 
ward into the corners.' The single e.xception to 
the al)ove arraignment is the Southern Pacific 
Hospital in 1 louston, which is a new institution. 

"Vou see, you gentlemen of the faculty gave us 
high ideals, and when we find others not living 
up to them it hurts a bit. 

"(iive my very best wishes to Drs. Nathan and 
FitzRandolph W'inslow. I hope they remember 
me: it's annoying to be forgotten! 

"To you. Dr. ^^'inslow, I am still deeply grate- 
ful for the good foundation you gave me in sur- 
ger\-. I am striving to adhere to your principles, 
and thus far I have been fairly successful. 

"(lood-by and good luck." 



hope that he ma\' many times again revisit hi- 
liome])lace with renewed pleasure each time. 



Dr. James Wesley Stack, class of 1893, is lo- 
cateil at W've Mills, Oueen Aime countv. 



Dr. Charles I'agley. Jr., class of 1904, has a 
paper entitled "Intestinal Perforation in Typhoid 
Fever" in the August (T911) issue of Surgery. 
Cyiu'cology and Obstetrics. 



Dr. FitzRandolph ^^'ins!ow, class of 1906, re- 
ports that "The bo)s have treated me out of 
sight" w liile on a recent trip to Cuba and Jamaica. 



Dr. C. Clarence IJillingslea, class of 1900, ?iledi- 
cal Corps, L^^. S. A., has been ordered to Columbia 
Barracks for duty. Dr. Billijigslea was formerh- 
assigned to the General Hospital, Presiflio of .San 
Francisco, Cal. 



Dr. Eugene Fauntleroy Cordell, class of 1868, 
has l)een visiting in Charleston, W. \'a. He 
writes : "This is my birthplace, and I am proud 
of it. Have met many old friends." We rejoice 
with Dr. Cordell in his well-earned vacation, and 



Tin; iiui.i.KTi.N is endeavoring to secure a biog- 
rai)hy of the life of each alumnus of the Univer- 
sity of Maryland. We would thank each one of 
our readers if they would send us an account of 
their life to date. 



Tile publishers of the Bulletin are very desir- 
ous of securing the following copies of the Bt.L- 
i.KTix : July, 1905 (\'ol. I, No. 5), January, 1907 
(Vol. 2, No. 11), and March. 1908 (A'ol. 4, No. 
i), A\'e would be more than glad if some of our 
readers could send us these missing issues. 



So far as is known, the living members of the 
class of 1871 are as follows: 

^^'m. A. l!o_\lston, Coushatta, La. 

Josiah R. Bromwell, 1147 Connecticut avenui- 
.v. W., Washington, D. C. 

Charles F. llevan, 807 Cathedral street. Haiti- 
more. 

Geo. F. Green, Dublin, Ga. 

Henry B. Gross, Jefferson, Md. 

John G. Jay, 817 N. Charles .street, Baltimore. 

Richard LI. Lewis, Raleigh, X. C. 

J. E. Massey, Rockhill, S. C. 

U'alter H. O'Neal, Gettysburg, Pa. 

Eugene Pendleton, Cuckoo, \'a. 

David J. Reinhart, 2432 N. Calvert street, BaL 
timore. 

Harrison Tongue, Elkridge, Md. 

(;;eo. G. Thomas, 315 iMarket street, Wilming- 
ton, X. C. 

Chas. H. Waters, T404 O street N. W., Wash- 
ington, D. C. 

Wm. W. Riley. Cumberland, Md. 

C. R. AMnterson, 1 lanover. .Md. 



Dr. Ejnar Hansen of 41 Ea>t 41st street, New- 
York city, class of 1904, writes us that "Every- 
thing is. as usual, here in old Xew York ; jjracticc 
slowly increasing, ami, thank heavens, the under- 
takers so far have not grown rich on my deaths. 
It seems such a long time since I was in Balti- 
more, but ho])e before long to make a short visit 
there. Since \ou heard from me last I have in- 
creased my family with a son. P.est regards to 
all." Dr. Hansen reports of the son: "He will 
be one year old Sejotember 1 1. He has his father's 
name with William van Hadrian put in as a gift. ' 



I V' 



THE HOSPITAL BULLETIN 



Wo CNU-n<l (iiir congratulations to Dr. Hansen, 
and hope that he will shortly visit Baltimore. \\ e 
\v(nilcl he delighted to see him again. 



Dr. j. Dawson Reeder, class of 1901, and -Mrs. 
Reedcr sjient the month of ^Viigust wath Mrs. 
feeder's jiarents. Mr, and Mrs. Thomas Briscoe 
t'iiinrle\\ at MoUand I'oint. Calvert count}'. Mary- 
land. 



There is a vacancy in the ])osition of resident 
])hvsician at the I'resliyterian Eye. Ear and Throat 

i lospital. 



We are exceedingly sorry to rejiort that a spe- 
cial jury called in Easton under Judge Philemon 
II, llo(i])cr lias adjudged Dr, Jamc-- Lux ]\IcCor- 
mick. class of 1884, as mentally irres]3onsil)le. -\ 
few years ago Dr, McCormick wa-^ well known 
as a hrilliant man, of fine character and acute 
sensihilil\ . 



Dr. e'harles R, Dilier, class of 187 _', of Detour. 
.Md.. who was operated on at the L'ni\-ersit\' i los- 
jiital recently, has entirely reco\-ered. Dr. Dilier 
is the father of Dr. Roland R. Dilier. class of 



Mis^ Lihie Hooker Carter. I'niversitv Hospital 
Training .School for Xurses. class of 1901J, who 
recently underwent an operation at the I'niversit}- 
I lospital, has recovered. 



Di". Joseph h". ( uchner. class of icSoo, is home 
fri im a trip to luiroiie. 



Amongst our Alumni located in Xcirth Caro- 
lina arc the following : 

Old Fort. 
'i . Morris Chaney. class of 1906. 

I'IC.MI'.ROKK. 

I'redericlc James Pate, class of 1908. 

PlOXIUCR AI1I.I..S. 

Jame^ Cyrus P.lack, class of 1906. 

PL^■MouTn. 
.\ll)hens Wood Disosway, class of 1903. 
W . II. W'ar<l. class of i88r. 
]\Ai.i:i(,ii. 
Richard Henry Lewis, class of 1871. 
John S. McKec, class of ]907. 



Watson Smith Rankin, class of 1901. 
Henry McKee Tucker, class of i8<)0. 
Joel W'hitaker. class of 1900. 

R.\xi).\L!'.rKi;. 
John Knox, class of 1906. 

Ricn Spkincs. 
llenjaiuin [■'. .McMillan, class of 1882. 
John Luther McMillan, class of i88i. 

Ricicnsviij,!-:. 
John ^^'. Mc( "ichee, class of 1904. 

R0.\N0KE R.\PIDS. 

liammer Carson Irwin, class of 1905. 

RoiiicKso.wir.i.i;. 
Rohert T. Hargrove, class of 1877. 
Jesse E, Ward, class of 1904, 
RocKiN(;ii.\.\i. 
Piatt Walker Covington, class of 1908. 
Avery Covington F.verett. class of 181)7. 
ITank J. ( iarrett, class of 1889. 
Lorenzo 1). McPhail, class of 1900. 

Rocky Morxi'. 

Emille Bonniwell Ouillen, class of 1904, 
William ]',. ]!orden. class of 1906, 
)>lark R. Ilraswcll. class of 1886. 
James Battle Phillips, Jr.. class of 1903. 
Rujiert Le l-io}- Savage, class of. 1897. 
i\. i I. Si)ei.L;IU. Jr.. class of 1901. 
(ieorge L. Winherly. Jr.. class of i88_:;. 

RoUGICiMO.NI'. 

\i. II. L\-on. cla.ss of 190.V 

Ro.XBORO. 

William .\. Bradshcar. class of 1904. 
liedfurd IC. Love, class of 1904. 

RUTHKRKOKDTOX. 

.\din .\dani Rucker. class of 1908. 

St. Paul's. 
T. .\IeL. X'cirthnip. class of 1897. 

.S.VLisr.uKV. 
1 lerman (i. 1 leili,g. class of 1899. 
Jaiucs Earnest Stokes, class of i8(;2. 

S.\Ll'll.\. 

E. ;\[cOueen Salley. class of 1903, 

Sc()Tr,.\xi) Xi:cK. 
I lem-y I. t'lark, class of 1879, 

Si:.\iM.\i^i). 
M, K. .Stephenson, class of i88r. 

Sh.vlt.otti:. 
James Alherl Stone, class of ii;03. 



Tllli IIOSIMTAL IIULIJ-.TIX 



Siii-:r.i'.\ . 
William I". :Mitclicll. class oi 1889. 

S 1 1 1 1 .0 1 1 . 
Wallor W. Sawyer, class of 1903. 

Sii.iCR Cn"^•. 
Slocoiiili Rupert lulwards, class of [908. 

Sl'EXCEK. 

Julian J. I'liizliy, class of 1904. 

Stark. 
Jiihn 1'.. Sliainlieri;er. class of l8c)0. 

SrATi-'sxii.i.i:. 
Elinor Ke\erc .\(Iains. class of 1878. 
.Vrchibald .\. Cannon, class of 1889. 
William Junius Hill, class of 1889. 
1 Fcnry Fletcher Long, class of 1892. 
John Eugene McJ^aughlin, class of 1886. 

Stokics. 
Thomas (1. ISasnight, class of 1904. 

Swan Quarter. 
Richard luigene Windley, class of 1903. 

S\ve:-:t Momf.. 
l-'dward King, class of 1892. 

SWKPSONAII.I.IC. 

Thomas R. Williams, class of 1877. 

TARIiORO. 

^^'alter Curtis Galloway, class of 1874. 
Samuel Xewburn llarrell, class of 1897. 

Trvox. 
luirl Grad}'. class of 1894. 

Wadesboro. 
Joseph 11. Bennett, class of 1894. 

Wallace. 
John \\'. Carroll, class of 1903. 

W^VRRENTON. 

Philemon J. ^Facon. class of 1883. 

Warsaw. 
James X. Williams, class of 1902. 

Wasi]iX(_;ton. 
Jack L. Nicholson, class of 1904. 
John W. Williams, class of 1906. 

\\'i:i'.ster. 
llarx-ey l". ISurgin. class of 1874. 

\Vi:sT Dl'ku A^r. 
I'.aird L'. lirooks, class of 1905. 

WlllTTAKERS. 

James C. Liraswell. class of 1882. 
Richard IT. Speiglit. class of 1870. 



Wii rriAiLi.i;. 
William II. Cmwell, class of 1895. 
llenr\- 11. Maxwell, class of l()02. 

WiLMix<rrox. 
Charles D. Hell, class of 1883. 
David William iSulluck, class of 1873. 
I'^rnest S. I'lulluck, class of 191 i. 
Thomas .Meares (jreen. class of 1900. 
Charles Thomas Harper, class of 1874. 
William 1). AlcAfillan, class of 1868. 
(ieorge Ci. Thomas, class of 1871. 
I'ride Jones Thomas, class of 1902. 
John (_"harles Wessel, class of i(po. 

^^''ILSox. 
George W. Lewis, class of 1886. 

WlXCATE. 

James Robert Jerome, class (if 1890. 
J. Lewis Hanes. class of 1902. 
W. Clinton Linville, class of 1903. 
Charles l^. Summers, class of 1887. 

WlXTERSVlLLE. 

R. Thaddeus Cox, class of 1888. 

WiT. 

William T. I'aul, class of 1869. 

A\'00DW0RTfI. 

\'ictor Moreau Eppes, class of 1882. 



Dr. Arnienius Cleveland Pole, class of iSjC). 
was stunned by lightning, which wrecked the 
upper floor of his home, 2038 Madison avenue, 
during a severe storm August 2ii. 



Drs. Henry ( ). Reik, class of 1891, and Dr. A. 
J. Xeilson Reik, class of 1900. are traveling in 
Europe. 



Dr. \Vatson Smith Rankin, class of i<;0[. has 
the follcjwing to sav regarding' standanl death 
rates in a recent bulletin of the Xortli Carolina 
lioard of Health : 

".Symptoms are abnormal manifestations of 
life. For example, the average ])ulse is about J2 
beats per minute, and a pulse much over or under 
that average is abnornial or unusual, and, as a 
rule, indicates troulile. As with the pulse, so with 
the other |.)henomena of life: the average and the 
normal are nearly alwaxs the same. Just as there 
is an average jjulse. an average number of res- 
jiirations. an average consum])tion of food, an 
average amount of waste thrown oft, all of which 
constitute w hat we regard as the normal, so there 



38 



THE HOSPITAL BULLETIN 



is ail avcraiic lunnbcr of deaths per year for a 
.^iveii population, an averag;e number of deaths 
from txphoid. from tuberculosis and other dis- 
eases, which constitute normal standards for es- 
timating health or disease conditions in a given 
community, town or State. ISefore one can rec- 
ognize the abnormal he nuisl l]e familiar with the 
normal, and liefore one is prepared to recognize 
symptoms of disease politic be must know the 
average total death rate and the average death 
rate for the different diseases that obtain in a 
large population. Such death rates have been col- 
lected and tabulated by the more progressive 
States that liave recognized the value of keeping 
an account with death, so that from a large col- 
lection of authoritative statistics we can tind the 
nc)rmal or average death rate for all diseases com- 
bined or for any particular disease. Fifty-five 
]>er cent., or 48,000,000 of the population of the 
L'nitecl States, are within the jurisdiction of rig- 
idly-enforced registration laws which supply the 
following statistics : Average annual death rate 
from all diseases is 15 per 1000; death rate from 
tuberculosis, 1675 per 100,000; for typhoid fever. 
22 per 100,000; for whooping-cough, 11 per 100,- 
000; measles, 10.2 per 100,000, and for malaria. 
2.5 per 100,000." 

This abstract was also reprinted in the Juiinial 
nj the .liiuTicaii Medical Association. 



Dr. Louis W. Talbntt. class of 1883. of Elkins. 
\V. Va., was a recent visitor to the L'niversity 
Hospital, where his wife was a ])atient. We arc 
glad to report that Mrs. Talbott has sufficientl}' 
recovered to return to her home. Dr. Talbott has 
practiced successfully in Elkins for a number of 
\ears. 



Miss Alice ]•". ISell, formerly superintendent of 
the L^niversity Hospital Training School for 
Xurses and graduate of the class of iyo6, has re- 
lurned from a visit to Toronto. 



Dr. David ^\ . Ihilluck, class of 1873, and Dr. 
lu-nest .S. r.ulluck, class of 191 i, announce their 
association in the i)ractice of medicine and general 
surgery at \\'ilmington, \. C, partnershi]) dating 
from August i, 191 1. Dr. David William I'.ulluck 
was born in Tarboro, N. C. June 1, 1833, a son of 
David William and Mary Margaret ( Routh ) Bul- 
luck. On the maternal side he is a descendant 
of Lord Hugh I'.ryant, who settled in .\merica in 



1710; of Major Aaron Lee of Westmoreland 
county, \'irginia, and of William Bulluck of Spit- 
hill, England. Through his mother he is de- 
scended from William Robert Routh of the fa- 
mous Routh banking house of London, England. 
Dr. Bulluck received his literary education dur- 
ing the years of the war between the North and 
the South, and, owing to the upset conditions 
then prevailing, was denied the advantages of a 
finished college course. His primary education 
was received at the hands of private teachers and 
in the high schools of Wilkerson and Belmont. 
Jn 1870, when but 17 years of age, he entered 
the medical department of the University of 
Maryland, graduating in 1873, then only 20 years 
of age. He served for a year as an interne at the 
University Hospital, and afterwards was for a time 
connected with the Associated Medical Charities of 
Baltimore, and then was for a while a member of 
the staff of the Mothers' and Babies' Hospital of 
.\'ew York City. While in New York he took 
special courses under Drs. Robert H. M. Dawbau- 
non and John A. Wj'eth, and also took a course in 
pathology under Professor Adler. Dr. Bulluck 
is an enthusiastic advocate of the post-graduate 
medical schools, and for many years spent part 
of each year in some such school. 

Dr. Bulluck began his professional course in 
Edgecombe county, North Carolina, where he 
resided until March 14, 1890. He then removed 
to Wilmington, where he has achieved remarkable 
success In his profession. He was the founder of 
the Catherine Kennedy Dispensary and Rest at 
Wilmington; one of the founders and organizers 
of the Associated Charities of \A"ilmington ; one 
of the organizers and for a time president of the 
.Association of Surgeons of the Atlantic Coast 
Line Railroad Co., and was founder and for six 
years surgeon to his own infirmary. He is a mem- 
ber of numerous medical societies, visiting sur- 
geon to no less than four hospitals and associa- 
tions, and has yet found time for many contribu- 
tions of value t(T medical journals througliout the 
country. 

Dr. Da\id llulluck married in November. 1880. 
Miss Maude Soutlierland Uraswell, daughter of 
.Archibald and Margaret (Clutclier) Praswell, of 
Edgecombe county, North Carolina. They have 
three children — David .Vrchie, a chemist; Maude 
Margaret, a musician, and Earnest Soutlierland 
Piulluck. a graduate of the class of 191 1, Univer- 
sity of Alaryland. and author of the ])a]K'r en- 



THE HOSPITAL BULLETIN 



'39 



thlcd "General Remarks nn l''.|)itlieliiima nl tin- 
Tongue, with a llrict Repoii nt a Recent Case ol 
Removal of This Organ liy I'mfessor Randolph 
Winslow," which appeared in the Xovemher 15. 
1910, issue of Till'; IIositiai, Uri.i.i-.rix. Dr. 
Ernest Bulluck was a house student during ilie 
session of kjio-km i . 



Dr. James A. .Xydegger. class of i<S<)2. Surgeon 
{'. S. P. 11. and M. 11. S.. has been granted two 
months' leave of absence Inim July 24, i()i 1. 



Dr. Alljerl I lynson Carroll, class of njoj- ^^'i" 
has spent the summer working with I )r. John ('. 
1 Icmmeter at Woods llole. Mass.. writes ;i-> fol- 
lows : 

"Dr. llemmeler is leaving this week fur I'.alti- 
more, and 1 return in a few days also. The work- 
here with him has been intensely interesting, and 
ihe course of work I undertook at the Marine 
liiological Laboratories under such men as 
Jacques Loeb, Lilly. Newman and Pike wa^ fin- 
ished satisfactorily. T have endeavored to cc|uii) 
myself as best I could fur the future. 1 came here 
jiartly on the advice uf Dr. Randdlph Winslow, 
and I am glad that I did. It has 1)een a pleasure 
to know personally such men as come here each 
year. Woods Hole is not a place for play. Men 
come here to work. It is much like a great sum- 
mer university. Jacques Loeli and others have 
been keenly interested in the jirogress of Dr. 
llemmeter's investigations. 1 feel that I have 
profited by having had the pleasure of assistin.u 
him. No one will ever know what an enornmus 
amount of actual labor was involved in the task. 
We have done intricate operatiems on hundreds 
of large dogfish alone, in order to secure the nor- 
mal as well as the inhibited hearts in suflicieui 
quantity to secure abundant material for analysis, 
."--and sharks, giant sea turtles etc, have also fur- 
nished valuable control material. Hut _\'ou will be 
much more interested in hearing about it on Dr. 
llemmeter's return." 



Dr. Horace ^I. Simmons, class of i88i, i> 
spending the late summer and early fall at Range- 
ley Lakes. Maine. 



Dr. I lenry lioteler Gross, class of 1S71, of Jef- 
ferson. I'Vetlerick county. Maryland, was born 
near Ih-ownsville, Washington county, Maryland, 
June 10, 1849, ^ SO" o^ Charles and I'.lizabelh D. 
Gross, and comes of American ancestr\'. He re- 
ceived his ])riniary education in the public schools 
of Frederick count}-. Frederick Academy and 
Mercersburg .\cademy of Mercersburg. l-'ranklin 
county. Pennsylvania.- He received his niedical 
education at the L'niversity of Maryland, entering 
ill [869 and graduating in 187 1. l^r. ( iross be.gan 
his professional career at Adamstown, remaining 
there for two years : then removed to Funkstown, 
Aid., where he practiced for 14 years. He located 
at Jefferson in 1887, where he has since built up 
a successful practice, (iovernor Smith in 1900 
a])pointed Dr. (iross a member of the Frederick 
County School Hoard. 

Dr. (iross married Miss Anna Hammond of 
l-rederick county, and has two children — Henry 
1 lammond and pjuma .Knita Gross. 



Dr. .\lejandro Ruiz Soler, class of 1906, has re- 
moved from Guayania. Porto Rico, to Orecil)o, 
Porto Rico. 



Dr. .Mackall R. I '.ruin, class of 1895. who until 
recentl}' was in Los Angeles. Cal.. is now with J. 
W. Wallace. Newark, Del. 



Miss Augusta Russell. L'niversity Hospital 
Training School for Nurses, class of 1909. is lo- 
cated at 1820 N. Charles street. 



Dr. \\'alter Henr}- O'Neal of (iettysburg, Pa., 
and a member of the class of 1871, was born in 
Baltimore, J\Id., September 23, 1849, the son of 
Dr. John \Y. C. O'Neal and Ellen Wirt O'Neal. 

1 fe attended the Baltimore public schools, and 
later Pennsylvania State College at Gettysburg. 
I le entered the L'niversity of Maryland in 1869, 
graduating in 1871, afterwards taking post-grad- 
uate studies in the departiuent of medicine of the 
L'niversity of Pennsylvania, and also in Bellevue 
1 lospital Medical College in New York city. Llis 
professional career began in Gettysburg in 1871, 
and continued until 1878, when he removed to 
I 'arsons, Luzerne county, spending six years there. 
I le then returned in 1884 to ( ".ettysburg. where he 
has since remained. Dr. O'Neal was physician 
iM Adams County .Vlmshouse from 1871 to 1878; 
then from 1890 to 1894, and from 1898 to 1900. 
He was a member of the Town Council of Gettvs- 



MO 



THE HOSPITAL BULLETIN 



!)Ui'g. ami in 1S91 was a incnibcr (if the C'ily 
Council. 1 le was elected president of the (iettws- 
hurg Water Co. in 1905. lie is a member of the 
American Medical Association and the Pennsyl- 
\'ania .State Medical Society, havin,^;' been its dele- 
gate to the meeting of the .\merican Medical As- 
sociation in i8cSo. Dr. (^'Xeal married in 1878 
.Miss Martha .\. May of rhila<leli)hia. lie has 
one son, also a physician — .Alexander I lay 
O'Neal, University of Pennsylvania, 1904. 



Dr. Robert I'arke ISay, class of 1^03, Medical 
Corps, Maryland National ( niard. has been made 
chief surgeon with rank of major, and has been 
assigned to the hirst lirigade, vice Major .\lexins 
.Mc( ilannan. resigned. 



Dr. William llenr\- h'isher, class of 1905, is 
one of the best-known physicians of the Eastern 
Shore. He is living in Centerville, but his prac- 
tice covers a large territory. Dr. Fisher is exceed- 
ingly popular. 



Dr. Newman Mall Dewis Co.x of Arlington, 
Ualtimore county, Maryland, graduate of the 
University of JMaryland Medical School, class of 
1902, is a native of Nova Scotia, born at Kings- 
port, January 28, 1868, the son of Ebenezer and 
Emma Dewis Cox. 1 le acquired his earlier edu- 
cation in the iniblic schools of Kingsport and the 
Halifax .\cademy at Halifax. I ie began the 
.-tudy of medicir.e at the L'niversity of New York 
(now New York L'niversity I, remaining there 
from 1891 to 1893, then entering the L'niversity 
of ISaltimore School of Medicine, graduating in 
i8c;3. lie was resident physician at the L'niver- 
sity Hospital from 1895 to 189^), and during the 
later part of 1896 was sent to \\^est .\frica as 
medical missionar\' under the Presbyterian Hoard 
of I'oreign Missions, remaining there until 1900. 
lie then returned to America and spent one win- 
ter at the |nlins ll(i])kins I los])ital of .Medicine, 
again receiving the degree of M.D. in n^oj. In 
-Mav, 1902, he l)egan the ])ractice of medicine at 
.\rlington. where he now lives. I )r. C'ox is now 
erecting a new home at the corner of J'{ogers and 
i'ark lleights avenues. Dr. Cox is a member of 
I'.rown .Memorial rresliyterian L'hurch, and was 
one of the organizers of the iMrst Presbyterian 
' 'hurch lit Arlington, of which he is an elder. I le 
married in iSc/i .Miss Louisa 1 lenriella lieyn, 



who accomiianieil him to .\frica and materiallv 
assisted him in his work. The_\- lia\-e two chil- 
dren — .Newman L'dliott, aged lO, ;ind Katherino 
Emma, atjed 8. 



Dr. Cideon .McD. \an I'oole, M:ijor, U. S. .\ . 
-M. I)., class of 1899, wa^ ordered to Dixon, 111.. 
on .\ugust 12 for temporary (hit_\-. Hr. \'an Poole 
is also detailed to re])resent the .Medical L)e[iart- 
ment, L'nited States .Army, at meeting of A.ssocia- 
tion of Military Surgeons of United States at 
-Milwaukee Septeruber 20-30, nji 1. 



Dr. Robert Lee llammond, class of 18S2, of 
Woodsboro. Md., has contributed a paper on 
"Pneumonitis" to the Medical B'-icf f<ir Septem- 
ber, i(;ii. I )r llammond savs : "I am protil 
to acknowledge the L'niversity as my alma mater. 
I have tried all my life to avoid anything that 
would bring discredit to my college and m\- 
class." The pa])er will apiiear in somewhat dif- 
ferent form in two other liicflical journals in the 
near futtu'e. 



MARRIAGES 



Dr. I larry A. Riuledge, class of \t)0~. of loi'S 
Jackson si|uare, and Miss .Natalie W. l'a\nter, 
daughter of Mr. and .Mrs. Warren l'a\nter. of 
2043 llottman street, eloped to Jackson\ille, \'a.. 
and Avere married there .\ugust 24, igii. Tlic 
bride annomiced the wedding to her parents ;i 
week later, when good wishes were extended tii. 
the couple. 



Dr. Artlun- Howard Mann, Jr., class of i8(;o. 
of C'atonsville, was married- to Miss Marv iv 
I'dgin of I'oolesville, .Md.. at noon on Aagn>t 20, 
1911. The ceremony was iierfornied at the par- 
sonage nf .Mt. L'alvaiy Protestant l".])i>copal 
(hurch by Rew I-'. II. .Staples. There were no 
attendants. The couple are nnw at the hunie of 
the groiim's mother, .Mrs. Ariluir I!. .Mann, at 
L';itonsville, .Md. 

Dr. .Mann was born at naltimore ( )clober 20. 
iSiii;. He recei\-ed his ])rimary education at the 
I'riend's .School and ( )\ford .School, graduating 
at the University of Maryland in 18110. and later 
taking a coui"se in N'ienna, An--tria. He i- well 
known among the ]jrofession in .Mar\kind. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., OCTOBER IS, 1911. 



No. 8 



A HURRIED TRIP THROUGH EUROPE. 



Bv T. A. AsHBY, M.D. 



(Contiintcd from Scl^tciiibcr 15//; Issue.) 

After three days of strenuous life in London 
we were compelled to take leave of this ancient 
and noble city, which for centuries has been the 
home of that great and learned and splendid race 
of people who have dominated the world and 
made the Anglo-Saxon name respected wherever 
civilization stands for all that is strong. We re- 
called the fact that our own ancestors, and those 
of many of our warmest friends, had been bred 
on English soil and had carried over to our homes 
in America the germs of religious freedom and 
of civic liberty which had made us the great na- 
tion we now are. The debt we Americans owe 
to Old England can only be fully appreciated 
when we visit her soil and study her splendid in- 
stitutions, her civil government, the domestic 
life of her people and her vast contributions to 
art, science and literature. We often hear on this 
side of the Atlantic suggestions about the decay 
of Great Britian ; we only see when we visit that 
country evidences of her growth and prosperity. 
We have only to contemplate her noble institu- 
tions to realize their dignity, solidity and en- 
durance. We should take pride in the fact that 
we have fallen heir to much that is great and 
good in her moral and intellectual development, 
to her wise laws and sound justice, to her honest 
business maxims and to her high literary culture. 
We must not deceive ourselves. Great Britian 
still leads the way in high standards of administra- 
tion, in thought, cultivation and in civic pride. 
We have much yet to learn from her. Her people 
are our nearest kindred. Her blood has warmed 
our hearts with her noble spirit and pride. 



We left London on Tuesday morning at 10 
o'clock via Victoria Station for the continent. 
The train which carried us from London to New- 
haven, on the English Channel, passes through a 
highly-cultivated farming country, showing all 
the evidences of a high art in crop-raising and 
pasturage. Every acre of land seems to be in 
service, and the woodlands are so clean that 
abundant pasture is afforded for sheep, cattle and 
horses. Towns, villages and picturesque farm- 
houses make the landscape pleasing to the eye as 
we are carried b\' rail through the counties of 
Surrey and Susse.x to the white cliffs bordering 
the English Channel. 

Our train reached Newhaven at 11.30, when wc 
took passage on the steamer for the French coast. 
The boat on which we embarked was a small 
craft, with flat bottom and no keel. It was 
crowded with passengers, and we had not gone 
five miles from the shore before we ran into a 
rough sea, which tossed the steamer fore and aft 
and from side to side with merciless vigor. The 
lurches and sudden motions to which we were 
subjected were irregular and uncertain ; many 
were made sick, and the sight of so much dis- 
tress was most unpleasant. Whilst I had no 
nausea, and to that extent was not seasick, I was 
uncomfortable. Imagine yourself being tossed in 
a blanket for some four hours, and the reader 
will realize what we experienced. I must confess 
I was most happy when we landed in the harbor 
of Dieppe. The distance across the Channel was 
some 50 miles, and we were about five hours in 
covering it. After landing in the ancient city of 
Dieppe, on the French coast, we had our first un- 
pleasant experience with custom-house officials. 
With our baggage we were conducted into a long 
shed, where the custom-house officers in gala 
uniforms waited upon us and inspected the bag- 
gage we had with us, I was asked to open the 



142 



THE HOSPITAL BULLETIN 



dress suit case which contained my clothing. 
After pulHng the contents into a mass of confu- 
sion, I was asked if I liad any cigars. Opening 
my coat, I pointed to some half dozen in my vest 
pocket, the last remains of the supply I had 
brought from home. With this exhibit I was 
allowed to escape the revenue duty imposed by 
the French Government on those who bring 
cigars and matches into that country. My friend, 
Mr. Page, was not so fortunate, as he had 
been more temperate in the use of his cigars than 
I had been. He still had in his suit case a half 
box of cigars and a good number of cigarettes. 
These were seized by the official, and a duty levied 
on them nearly equal to their purchase price. Mr. 
Page paid this duty, and very generously allowe.l 
me to smoke his cigars before we reached the 
custom-house officials on the border line where 
we entered Switzerland. I would suggest to those 
who smoke cigars and cigarettes to carry a very 
small supply when they enter French territory. 
The tax on tobacco in F"rance is very high, and 
the cigars one buys in that countrv are very in- 
ditTerent and very high. Thanks to Mr. Page, I 
smoked very few French cigars. 

The train we took at Dieppe was so crowded 
that we had some difficulty in finding comfortable 
seats. Some eight people, men and women, were 
packed like sardines in a small compartment 
crowded with hand luggage, with scarcely space 
for comfortable sitting. I soon made an escape 
into the passage-way extending along the side of 
the car its entire length and connecting with 
open doorways tiie different comijartments. 
Glass windows open out from the passage-way, 
giving plenty of air and view from the car. I 
stood by one of these open windows during the 
entire run from Dieppe to Rouen and dur- 
ing the greater portion of the distance from 
Rouen to Paris, a total distance of over 
150 miles. The scenery from the window and 
the privilege of smoking compensated for the 
discomfort of standing. The run from Dieppe 
is through a rolling countr)', presenting many 
beautiful landscape pictures. The farm lands, 
forests and meadows show that the hands of man 
have been busy in the centuries past bringing 
these lands to the highest state of fertility and 
productive value. The towns, villages and farm- 
houses were built almost entirely of brick and 
stone, with roofs of tile or thatch, giving an old 
and quaint appearance to the buildings. Many 



of these buildings look as if they had been stand- 
ing for centuries. At Rouen we crossed the 
Seine to the south bank, and from Rouen to 
Paris, a distance of some 100 miles, the railroad 
follows the west by south shore all the way to 
Paris. 

Rouen is a very ancient city of Normandy, full 
of historic interest. It is located on both banks 
of the Seine, surrounded by very high ranges of 
hills, which give a very picturesque appearance 
to the city. At Rouen we enter the \"aUey of the 
Seine, and at once come into one of the richest 
agricultural sections of France. The valley is 
from two to five miles in width ; the bottom lands 
are level as a floor, extending from the river 
banks to the foothills and up the foothills from 
200 to 500 feet to the skyline, presenting from 
the car window a picture of rare beauty. These 
lands are in the highest state of cultivation, every 
acre covered with green grass or crops of grain. 
The manner of cultivation is novel to an Ameri- 
can. The crops are planted in strips varying in 
width from 100 to 300 feet, and in length from 
100 yards to one or more miles. In one strip is 
grass ; another wheat : another potatoes, and a 
fourth oats, running parallel. At the time of our 
trip the wheat and oats were being harvested. 
The eft'ect presented by the golden grain and the 
green alfalfa, grass and potatoes was not only 
striking, but pleasing to the eye. As there are no 
fences and no buildings, the landscape for miles 
and miles was one continuous succession of alter- 
nating crops. There were no apparent lines be- 
tween the different farms, which were evidently 
small, judging from the size and alternations of 
the sections in cultivation ; not a few of these sec- 
tions were not larger than two or three acres, yet 
the grass, potatoes, wheat and oats were all grow- 
ing on these small farms. Men and women were 
busy cutting and gathering in the wheat and oats, 
using in most instances the cradle or sickle to cut 
the crop. I saw less than a half dozen reapers in 
use during my entire trip through Eurojje. 
\\'omen were working in the fields with the men. 
whilst the cow, the o.x and the dog are commonly 
used to haul in the crops. 1 shall take occasion 
later on to refer to these primitive methods of 
farming in Europe. Another striking feature of 
farm life which we observed for the first time in 
a most marked manner in the Valley of the Seine 
is the almost total absence of farmhouses on these 
farm lands. The farming classes live in villages 



THE HOSPITAL BULLETIN 



143 



or small towns, and i^n to their farms nn fciot, or, 
very fre(|ut'ntly, on the bicycle, to do their work. 
These collections of farmhouses, with their out- 
building's for stock and grain, are located every 
few miles apart within convenient reach of the 
farm lands. These homes of the people appear to 
be well constructed and arranged. They recall 
the customs and practices of remote times, \\hen 
personal safety made such settlements a necessity. 

In no respect does the method of living in our 
country and in Europe differ more than in the 
conduct of the farm and in the domestic life of 
the people who cultivate the soil. 

The farmer in Europe, for the most part, is a 
jieasant, content w'ith small things and living a 
life of hardship, toil, simplicity and, we believe, 
contentment. W'e know what the farm life means 
to the majority of the farmers of our country. 
I must express the opinion that we do not appre- 
ciate the difference in our favor — the life of inde- 
pendence, of refinement, of solid comfort, of suc- 
cessful results, the larger ways of doing things, 
but, alas ! also the wastefulness, idleness of farm 
labor and unscientific methods of farm manage- 
ment, so common in man}- sections. The com- 
parison does not cease here ! The peasant farmer 
in b'urope is a man of toil and industr\-, but he 
makes both yield results. The few acres of land 
he cultivates are brought to a higli state of fer- 
tilitw and bring forth crops that amply repay for 
the labor and care expended upon them. I have 
never seen such wheat and oat fields as I saw in 
sections of Frarice and Germany through which 
I passed. The yield of grain and straw must be 
enormous, as compared to the average per acre in 
tliis country. 

I was charmed with the clean and neat appear- 
ance of the farm lands, the absence of weeds. 
undergrowths of brush and other evidences of 
careless methods of farming. The natural con- 
dition of the soil in the larger ])ortions of b" ranee 
and Germany is not as good as we find in many 
of the States of this country, but intelligent farm- 
ing has so improved these natural conditions that 
poor lands have been made rich and waste places 
liave been brought into use. What has been done 
in European countries, densely populated, is only 
an indication of the agricultural possibilities of 
iiur nwn country when the growth of population 
will demand more scientific methods of agricul- 
ture. If tJie thousands of acres of waste lands, 
of forests and swamps in this country were matle 



to render a useful service under proper manage- 
ment, they could be made to yield more food 
products than all the farm lantls of England, 
I- ranee and Germany combined. ( )ur agricultural 
possibilities are so vast as to make us land poor. 
We reached Paris at 7 o'clock in the afternoon, 
after a continuous run of ten hours from London. 
We selected the London and New York Hotel, on 
account of its central location and from the fact 
that it is very largely patronized by Eng-lish-speak- 
ing people. We found pleasant rooms, a first- 
class table and very agreeable people with whom 
we could converse. After dining we secured a 
two-seated victoria, driven by a shriveled up old 
Frenchman, wdio wore a faded blue livery and a 
high-crowned leather beaver, with cockade, which 
gave him a very important look. He spoke 
enough English to make us understand what be 
liointed out to us. We gave him instructions to 
show us all that was worth seeing in two hours. 
He had evidently acted as a guide on other occa- 
sions, for we were shown the most beautiful 
avenues, buildings and monuments, all illmninateil 
\\ith electric lights. This drive after dark over 
the city gave us a splendid o]3p(.)rtunity to see 
Paris all brilliant and gay. with thousands of 
people lining the streets, public parks and cafes. 
Alen. women and children not a few were seated 
on the pavement around small tables in front of 
innumerable eating-houses, all eating and drink- 
ing merrily, whilst bands of music were playing 
in many of the larger halls. The crowd seemed 
good-natured and happy. As we observed these 
people one might conclude that they were an idle, 
frivolous set, but such is far from the case. 
These people all belong to the middle and work- 
ing classes. They are energetic, thrifty and sav- 
ing, intent on business during working hours and 
on simple pleasures after the day's work is over. 
The\- take a frugal breakfast and lunch, and for 
dinner go to the dining houses for more substan-" 
tial food and, for light wines and beer, which they 
drink freely, but seldom, if ever, to mtoxication. 
Whilst I saw a great deal of wine and beer drink- 
ing in Europe, I did not see a single intoxicated 
person, nor one that was in the least disagreeable, 
rude or impolite. After several hours uf sight- 
seeing we retired to our rooms for a night's rest. 
The following morning, after breakfast, we again 
secured the services of the old Frenchman and 
his victoria, and were driven many miles through 
the city and parks, stopping at many of the noted 



144 



THE HOSPITAL BULLETIN 



I'ublic buildings for closer inspection and a visit 
within. In this way we saw Notre Dame, the 
Pantheon, Louvre, Napoleon's Tomb, Eiffel 
Tower, Arc de Triomphe, Place de la Concorde, 
Church of La Madeleine, Place Vendome with 
its imposing column, Column of the Bastile, 
Statue of the Republic and many other public 
buildings, monuments and objects of historic in- 
terest. Afterwards we were driven through the 
Champs Elysees and the Bois de Boulogne, the 
two most noted parks in France. 

I have neither the space nor the ability to write 
up the varied objects of interest in a way to do 
justice to the subject or to give a clear description 
of each. I shall only attempt to point out a few 
of the sights in which one can always find an in- 
terest, which may direct the attention of the 
reader to them should he ever visit Paris. 

These places are all historic, and have been 
fully written up in guidebooks and in books of 
travel. It seems unnecessary to do more than 
mention them. Impressions are very lasting when 
careful observation has been made. We form 
o])inions from these impressions, and they ever 
after give shape to our ideas and ideals. In this 
way our mental faculties create new tastes and 
sentiments, and cultivate a love for the beautiful 
and the true in nature, art and literature. The 
impression we get from a close view of these 
beautiful buildings, works of art and triumph over 
nature is that man's artistic taste and sense have 
been developed to the very highest state of per- 
fection. Notre Dame, for example, is a marvel 
of architectural beauty and grandeur. I cannot 
see how it could be improved upon. It certainly 
surpasses any of the cathedrals I saw in Europe 
in size and quality of building material and in 
richness of architectural display. Yet, with all 
this, it was cold in its effect upon mv sentiments, 
and did not touch tlic soft spots in my heart, as 
-did the services I attended in St. Paul's, in Lon- 
don, or the sweet tones from the bells in the 
Cathedral at Cologne. I greatly admired Notre 
Dame, but did not fall in love with her beautiful 
walls and stately cohnnns, a most noble specimen 
of Gothic architecture. For centuries royal coro- 
nations, weddings, baptisms and burial services 
have been conducted within its walls, which, if 
endowed with the faculty of speech, could tell 
of joys and sorrows without number. 

The visit to the Pantheon was very impressive. 
This large and beautiful building, modeled after 



the Pantheon in Rome, from which the building 
of the Medical Department of the Ll^niversity of 
Maryland was also copied, is the Westminster 
Abbey of Paris. It is built of very durable stone, 
with stately pillars in front and lofty dome above. 
Its interior is large and handsome, with large 
columns supporting the roof and dome. In the 
halls and corridors are statues and statuary repre- 
senting ancient kings and rulers, men of distinc- 
tion and renown, in every calling ; tablets, me- 
morials, busts all designed to express the esteem 
in which these dead are held by the people of 
France. These tributes to the dead are located 
on the main floor of the building. Following a 
crowd led b}" a guide we were conducted to a 
cellar beneath, a dark and gloomy underground 
cavern, with avenues and passage-ways leading 
right and left, in which were deposited in dismal 
vaults the last remains of many of the great men 
who have served France in the years long gone 
by. The guide, with candle in hand, led the way, 
and as we groped in the dark would halt in front 
of one of these chambers and discourse in French 
tin the deeds, valor and lives of these long-forgot- 
ten dead. I can recall the tombs containing the 
last of all that remains of Voltaire, Carnot and 
a few other noted men who did so much to make 
history in France. Resting in these old under- 
ground vaults, where the light of day never pene- 
trates, and where few could ever see their silent 
tombs, I felt no desire for an immortality which 
would consign my body after death to a gloomy 
cavern beneath a stately Pantheon. Far more 
comforting is it to my soul to feel that when it 
leaves the house in which it has dwelt the house 
shall dissolve away and its components shall re- 
turn to mother earth in a natural way. I do not 
envy those who covet the privilege of sleeping 
in this gloomy cave beneath the Pantheon. 

To visit Paris and not see the Louvre is an un- 
fortunate oversight. This great storehouse of art, 
with its enormous buildings and beautiful gar- 
dens, covers man)- acres of ground in the very 
heart of Paris. It is a grand monument to the 
genius, culture and artistic taste of the French 
jieople. There is perhaps no larger number, and 
certainly no greater variety, of works of art col- 
lected under one roof in any country of the world 
than can be found in the Louvre. Acres of floor 
space and walls have been given up to these col- 
lections of sculi)ture, paintings, tapestries, por- 
celain and china wares, coins and bric-a-brac, 



THE HOSPITAL BULLETIN 



145 



rfpresfiiling the work of all countries and cover- 
ing every age from prehistoric days to our time. 
These rare works of art have heen selected with 
the greatest care, and liave heen arranged and dis- 
played with rare skill. We walked through the 
rooms and corridors oi this enormous building 
until our feet were sore. I am sure we saw only 
a small portion of the collections. One could 
spend weeks in an inspection and still find new 
objects to interest and instruct his mental facul- 
ties. Tn the halls devoted to sculpture we found 
many of the busts and statues brought from 
Egypt, Greece and Rome. The Caesars — Julius, 
Augustus, Tiberius and Nero — were in evidence 
here, as in the British Museum, showing the 
vanity of this family and the very liberal way in 
which they had themselves represented in marble. 

The French have been centuries in gathering 
together the vast treasures of art now found in 
the Louvre. Ancient and medieval art predomi- 
nates over that of modern times. It is in this 
love for the antique that Europe excels our own 
country. The time may soon come wdien we in 
America will excel European art galleries in mod- 
ern works of art. We can hardly hope, even with 
the patronage of our men of wealth, to gather in 
one musuem any large number of the classical 
works of art now found in European countries. 
It is true that enormous prices are now being 
jiaid in our own country, and even in our own 
city, for many of the gems of art held in private 
galleries in Italy, Germany and France. With 
our increasing wealth and love of art we may 
hope in the future to possess many of the old 
masterpieces so richly prized by the art collector. 
W'e must beware, however, of imitations, and not 
accept all the material offered us as genuine. The 
large art museums in Europe are owned and 
subsidized by the Government. Our Government 
supports no similar institution. The library in 
Washington and the Smithsonian Institute are 
the nearest approach which our nation has made 
to literary and scientific collections. The fine 
arts, statuary and paintings do not as yet appeal 
in a large way to the nation's liberality. 

There are many other objects of interest in 
Paris worthy of extended notice. The space at 
my command does not admit of further details. 
T can only give the general impression I re- 
ceived and leave the observations made for some 
future use. The most lasting impression made 
is that Paris is a most beautiful city, surj)assing, 



in my own t)pinion, any of the large cities I vis- 
ited in Europe. Its many miles of broad streets 
and avenues, lined with splendid and substantial 
buildings of almost uniform height and width, 
with highly ornamental fronts — the average 
height seldom under five stories and very rarely 
over six or seven, giving an almost uniform sky- 
Ime — its beautiful open squares and parks radiant 
with blooming flowers and ornamental shrubs and 
plants, its grand monuments and bridges cross- 
ing the Seine, its clean and well-kept appearance 
— all indicate the high artistic taste and love of 
the useful and beautiful of the Parisian people. 
This love of art enters into the smallest details, 
for the signs on the buildings, the beautiful dis- 
plays of goods and wares in the show windows, 
and even the advertising devices, are made so 
attractive as to command notice and admiration. 

In size, appearance, general bearing and dress 
the French men and women more nearly resemble 
the people of our country than do our nearer 
kindred in England. The crowds of people we 
meet in the shopping districts of Paris so closely 
resemble the men and women we meet during 
our shopping hours on Lexington street, in Bal- 
timore, that we could readily imagine we were at 
home, did not the wider streets and sidewalks 
and more elaborate buildings in Paris indicate 
the dift'erence. The men and women in Paris, 
with few exceptions, are neatly or handsomely 
dressed; their general style is attractive; their 
manner is easy and deferential, all indicating 
good breeding and kindness of disposition. I 
believe that the people of our own city have these 
same characteristics to an equal degree, and we 
may feel a just pride in the refinement and good 
breeding of our own citizenship. Long before 
we have reached the age of Paris, Baltimore 
should occupy a higher position in culture, art 
and in all the refinements of life than our Pa- 
risian neighbors now occupy. This is claiming 
a great deal for our city, but I think we have the 
pride of citizenship and of endeavor, a love for 
the artistic and beautiful, to go after these re- 
sults. It is quite certain that no community, how- 
ever large or small, can rise to the high planes of 
refinement and culture if in every class of citizens 
the love of the good and the beautiful is not culti- 
vated side by side with the useful. Among the 
poor, as among the rich, there are high ideals and 
sentiments lying dormant which can only be 
quickened into action and force by the influence 



146 



THE HOSPITAL BULLETIN 



and leadership of those who govern our States 
and municipahties and control our national life 
and spirit. In the homes of the poorest classes 
in rural Europe cleanliness and flowers were 
more in evidence than dirt and weeds. I saw no 
pig pens, unclean!)' barnyards, decayed fences or 
filthy fields in any of my travels, but cleanliness, 
flowers and attractive homes were everywhere. 
Whilst I did not see the interior of any of these 
homes, I have no doubt they were as well kept as 
their exterior surroundings. 

During the last two days we were in Paris we 
were on the constant go. except when eating and 
sleeping. By making the best use of our feet and 
of cabs we were able to cover a very large terri- 
tory and to see many objects of interest. Our 
muscles and nerve cells were worked to their 
fullest capacity. We were too tired to remain 
longer in Paris without a day of rest. We there- 
fore sought in travel the rest of body and relaxa- 
tion made necessary by our strenuous life. 

On Friday, July 21, at 8.20 o'clock, we took 
the train at Paris for Interlaken, Switzerland. 
The day was excessively warm, and the cars 
were crowded with people, many, like ourselves, 
tourists. Our ride from Paris to Dijon con- 
sumed five hours. I do not think I have ever 
experienced more discomfort in any five hours of 
my life than on this trip. There was no drinking 
water to be had on the train, and my thirst was 
made intense by the heat. At Dijon we secured 
in the depot a small bottle of stale apoUinaris 
water, too warm to satisfy thirst or to cool one's 
li])s. At Dijon a section of our train was 
switched off, leaving the locomotive a less num- 
ber of cars to pull over the Alps. It was not until 
we reached the Swiss border, at 4 P. M., that 
any comfort was secured. Here we were detained 
some 20 minutes until the custom-house officials 
were able to inspect our baggage. During this 
interval we found sandwiches, fruits, milk and 
cold drinks in greatest abundance. I never en- 
joyed cold water so much in my life. The ride 
across the Alps after our bodily wants had been 
supplied was one of the most beautiful expe- 
riences of my life. The scenery from the car 
window defies my powers of description. As we 
ascended and descended the tall peaks of the 
mountains, the views of canyons, lakes and moun- 
tains in the distance was one panorama of nature 
in her noblest and wildest forms, whilst the inge- 
nuit\' and toil of man had made mountains and 



valleys pay tribute to his industry. \"inc-clad hills, 
grazing lands, meadows of hay, manufacturing 
establishments, beautiful homes and villages 
(lotted the landscape on every side. At Neufchatel 
we reached the valley and coursed along the lake 
until we arrived at Berne. Here two very culti- 
vated young French ladies whose acquaintance 
we had made on the train said good-bve to us. 
These young women spoke English with sufficient 
ease to be entertaining. They were so refined, 
afi'able and agreeable that we were more than 
sorry to part with them. 

I may say jiere that the acquaintance one 
makes in travel adds greatly to the pleasure. 
^Vherever we went we met with people in our 
car or boat who proved to be friends and com- 
I)anions of short acquaintance, but of most agree- 
able manners and kindly ways. We felt that we 
were with friends on all occasions. The ties of 
blood are strong, but the whole human familv 
seems drawn together when one goes from place 
to place and meets with the stranger in a strange 
land. 

Berne, the capital of Switzerland, is beautifully 
situated in a fertile valley surrounded with lofty 
mountains with tops covered with snow. The 
farm lands and meadows were in highest state of 
cultivation. Large herds of cows were seen 
grazing in many fields, making cheese and but- 
ter the great products of this section. I-'rom 
Berne to Interlaken the railroad followed the 
borders of Lake Thun, which were lined with 
beautiful villas, hotels and many small villages, 
all lit up with electricity. At 9.30 we reached 
the Royal George Hotel, in Interlaken, after a 
continuous run of over 13 hours from Paris. 
[to be continued.] 



The Bulletin has been asked to announce that 
the \\'estern State Hospital, located at Staunton, 
\'a., desires the services of a young physician in 
the drug department, which pays $50 a month, 
board and washing. The doctor who referred 
the request to us states that the duties are light, 
and the holder of the position would have ample 
leisure to see any of the work of the institution 
he would care to. The hospital is a State insti- 
tution, and there are from 1200 to 1800 patients 
there all the time. Almost all kinds of mental 
troubles may be seen there except epilepsy, which 
is treated in a separate institution. Dr. Joseph S. 
Dejarnette is the superintendent. 



THE HOSPITAL BULLETIN 



147 



SEE AMERICA FIRST. 



r>\- l\ wDDi.i'ii W'lxsrnw. 



2. r.OS ANGia.lCS AND N'lCINITY. 

Los Angeles is a reniarkahlc city : startini^^ as a 
]\Iexican pueblo of 4') jjersoiis in 1781, it has de- 
veloped into a handsome modern city of 319,000 
inhabitants, according to the census of 1910. 
During the past decade it has increased 2ii]A per 
cent, in population. With the peculiar optimism 
of the ^^'est. it is prophesied that the population 
of the city will reach 1,000.000 in 1920. What 
has caused this sudden increase in the number of 
its inhabitants? Doubtless manv factors; but the 



this section of our country. A very strange con- 
dition is the presence of hundreds of oil wells 
within the city limits, and often in the yards of 
the houses. Equally as strange a sight is that of 
oil derricks out in the ocean some distance from 
the shore, in active operation. There are so many 
pkices of interest at Los Angeles that a medical 
meeting is apt to suffer from the truancy of its 
members. I fear the A. M. A. was no exception 
in this regard, and I confess that personally I did 
not attend either the meetings of the House of 
Delegates, or of the surgical section as faithfully 
as might have been desirable. Considering the 
distance from the great centers of population, the 
attendance was very good, the registration of 
members being 2153, many of whom were accom- 




ANCIENT MISSION, SANTA BARBARA, CAL. 



location of the city and its splendid climate are 
probably the most important. The city is about 
25 miles from the Pacific Ocean, while behind it 
at a somewhat less distance is the coast range of 
the Sierra Madre mountains. The climate is dry, 
equable, and never oppressively hot or too cold. 
The nights are always cool, and even in summer 
a light overcoat is often a comfort. The business 
portion of the city does not differ materially from 
similar sections of most'other large towns, but the 
residential streets are lined with handsome homes, 
which are set apart, surrounded by more or less 
ground, with beautiful flowers and flowering 
plants, and vines trailing over the houses. The 
residences are most of them bungalows, though 
many are built in the Spanish mission style of 
architecture, which seems peculiarly adapted to 



panied by their wives and daughters. I think the 
session was a good one, but nothing surgical of 
an\' especial importance was brought out. So- 
cially the meeting was a great success. The 
president's reception was given in the ballroom 
of the Shrine Auditorium and was a brilliant af- 
fair. With two such men as William H. Welch, 
the retiring president, and John B. Murphy, the 
active president of the American Medical Asso- 
ciation, receiving together, the occasion was 
bound to be memorable. I had the pleasure of 
meeting here Dr. Rupert Blue of the class of 
1892, who rid San Francisco of bubonic plague a 
few years ago, and who is now engaged in ex- 
terminating the ground squirrels over a large area 
of country contiguous to San Francisco. The 
ground squirrels have become infected from rats 



148 



THE HOSPITAL BULLETIN 



and are agents for the propagation of the plague. 
A unique entertainment was the smoker and 
vaudeville performance nn the roof of the Ham- 
burger Building. This is an eight-story building 
with an open and battleniented roof, upon which 
the smoker was held. It is estimated that from 
5000 to 6000 persons were present, and 
were served with beer without stint, cigars and 
other refreshments suitable to the occasion, with 
music, boxing and w'restling as entrees. All the 
work of the session was brought to a close on the 
third day, a day earlier than usual, and on Friday 
Adolphus Busch gave a Spanish luncheon and 
fete at his magnificent sunken gardens at Pasa- 
dena. The day was beautiful and the gardens 
and grounds wonderful ; bands discoursed music, 



Los Angeles, where the Government has estab- 
lished huge breakwaters to render the harbor safe. 
We saw here quite a large squadron of United 
States warships, as well as many large coastwise 
steamers. Off the coast zj miles from San Pedro 
is Santa Catalina Island, a picturesque and beau- 
tiful island, 22 miles long and from one to eight 
miles wide, and very mountainous and rugged. 
At one time it supported a large population of 
Indians, but these have all disappeared, and the 
permanent inhabitants are but few. It is reached 
by ocean steamer from San Pedro, and on the 
day the writer made the trip the skies were bright 
and the sea smooth, and but few persons yielded 
to nial de nier. The landing place is Avalon, a 
seaside resort, with some fair hotels, but most of 




BUS lis SU.NKKN- (iAUUEXS. I'ASAUENA, CAI,. 



and Anheuser-Busch beer flowed in streams, or 
rather from bottles. Beeves and hogs were bar- 
becued, and the crowd thronged and surged in its 
efforts to reach the serving tables and did not get 
much but ruffled tempers, rumpled clothes and in- 
digestible meat. The power of wealth is well 
exhibited in the transformation of barren and 
rocky hillsides and rubble vales into the loveliness 
and beauty of the Busch gardens. Pasadena, 
which is only 10 miles from Los Angeles, is the 
rich man's colony, and here we see the magnificent 
homes and beautifully kept grounds of the multi- 
millionaires. The suburban, or interurban, elec- 
tric lines of Los Angeles radiate in every direc- 
tion, and for a small fare one can travel almost 
anywhere within a radius of 100 miles. Twenty- 
five miles to the west is San Pedro, the seaport of 



the visitors prefer to live in tents in large camps, 
where, doubtless, the formalities and conven- 
tionalities of society are largely dispensed with. 
For the transient excursionist the most interesting 
thing is a view of the marine gardens, or aquatic 
plant and fish life through the glass bottomed 
boats. The water is very clear and objects many 
feet below the surface can be distinctly seen. 
Bo\-s and young men clad only in trunks, and 
with limbs and necks of a deep tan color, dive 
from boats for coins tossed into the water, and 
liut seldom do they fail to catch the coin before it 
reaches the bottom. They also dive for abalone 
shells, which they bring up from the bottom at a 
depth of 25 or 30 feet and sell to passengers on the 
boats. It detracts somewhat from the interest of 
the ])rocedure to learn that the shells have been 



TIIR HOSPITAL liULLKTlX 



149 



placed in the water by the same individuals, and 
that they did not grow there. It certainly is a 
strenuous way of earning a livelihood, and one 
does not begrudge them the stipend they receive. 
There is a fine ai|uarium at Avalon, where fishes 
found on the Pacific Coast can be seen. Seals 
also resort to this beach, where they are fed ; 
while on the more remote and inaccessible ])arts 
of the island wild goats are to be found in abun- 
dance, the hunting of which has become a famous 
sport. These goats are not any peculiar species, 
but simply the ordinary billy and nanny that have 
reverted to a wild state from lack of care. 

On the trip to and from Catalina we saw a 



these missions, established by Fra Junipero 
Sierra, along the coast of Southern and Central 
California, are now in ruins, but several are still 
in a good state of preservation and are objects 
of interest, and doubtless of veneration, to many. 
\\'hitier is a town established by Quakers, 13 
miles from Los Angeles, where there is a flour- 
ishing college and a prosperous farming com- 
munity, which with many other towns and cities, 
are found within a radius of 30 miles and are 
easily and speedily reached b\- the electric railway 
s\stem. 

The hotels of Los Angeles are mostly new and 
handsome, and one can get any accommodation 




AVALON", S.\NT.\ c AT.\I.IX.V ISI.AMi. CAL.. 



number of flying fishes that were several times 
as large as those I have seen on the Atlantic 
Ocean, and which flew a much greater distance. 
They looked like birds as they skimmed over the 
water. As has been stated, the suburban electric 
roads of Los Angeles are remarkable. From the 
Pacific Electric Railway station trains run in all 
directions : to the coast, to Long Beach, Venice 
of .America. San Pedro and other points ; to the 
nmuntains. to iNIount Lowe, with its remarkable 
inclined railroad, and to Mount Wilson, 6000 feet 
in height, from which a magnificent view of the 
surrounding country can be had ; to San Gabriel 
Mission, one of the remaining Spanish missions 
that was built in the latter part of the eighteenth 
century by the Francisan monks and that are still 
kept up and used as places of worship. Most of 



that he may desire. If he prefers to live at a small 
cost, he can get his meals at a caffeteria, which is 
a restaurant at which one helps himself, and for 
25 to 40 cents can get as much as he can eat. If 
he prefers more style, there are many other places 
of entertainment where he can find style, but will 
not fare any better. Los Angeles appears to be a 
place where the conditions of life are exception- 
ally easy and agreeable. 



Dr. William Benjamin Borden, class of 1906, 
First Lieutenani, Medical Reserve Corps, \J. S. 
.\., has been ordered to proceed to Manila, P. I., 
on the transport sailing from San Francisco on 
or about January 5, IQ12, and on arrival will re- 
jiort in person to the commanding general, Philip- 
iiine Division, for assio-nment to dutv. 



iqo 



THE HOSPITAL BULLETIN 



GUNSHOT WOUNDS OF THE SPINAL 
CORD. 



By C. L. Dries, 'ii, 
Senior Medical Student. 



Wounds by gunshot, especially those which in- 
volve the spinal cord, are always of a very serious 
import. In recent wars the frequency of wounds 
involving either the spine or the spinal cord ap- 
pears to have somewhat increased. 

In the American Civil War about one-fourth of 
I per cent, of all wounds were wounds of this 
region. 

In the Spanish-American War and the Philip- 
pine Insurrection this proportion was more than 
doubled. 

The increase in frequency of fracture of the 
spine, with or without involvement of the spinal 
cord, is probably due to the greater penetrating 
power of the modern bullet. With the older bul- 
lets not only did the bullets not penetrate so deeply 
into the tissues, but they were frequently arrested 
by the resistant structures about the spine or by 
the vertebrae. 

The mortality in recent wars is high, higher 
even than with the older missiles, this probably 
being due to the fact just named, that is, that the 
modern bullet is more likely to pass through the 
vertebra and to reach the cord. 

In the Civil War 55.5 per cent, of all spinal 
fractures ended fatally. 

In the Spanish-American War the mortality 
was as high as 66.6 per cent., and in the Anglo- 
Boer War the mortality in 48 cases was 58.3 per 
cent. 

Infection enters as an important factor, espe- 
cially in cases which terminate fatally. When in- 
fection occurs, the resulting meningeal inflamn;a- 
tion is even more apt to end in death than in sim- 
ilar involvement of the intracranial structures. 

In involvement of the cord, the cord may be 
concussed, compressed or entirely destroyed. 

Concussion, unless it is severe, is usually more 
or less rapidly recovered from ; but when the cord 
is compressed, or is partly or wholly destroyed, 
the injury assumes a very serious character. 

Degenerative changes often go on with aston- 
isJiing rapidity, together with deep sloughing bed 
sores and cystitis. 

The surgeons in the Boer War spoke particu- 
larly of the painful and distressing features in 



their cases, and state that no cases in the hospital 
seemed more hopeless or more distressing. 

Concussion of the spinal cord by gunshot is due 
to the shock of impact of the missile or the molec- 
ular vibrations set up by the passage of the missile 
at high velocity near the cord. The effect of such 
injury may be transitory pain and loss of muscular 
control or complete paralysis, and anesthesia with 
liersistent pain and general neurasthenic symp- 
toms. 

Cojnpressioi! of the cord may be due to hemor- 
rhage, to depressed fragments of bone, or to pres- 
sure from a lodged missile. L'nless the compres- 
sion of the cord is great, complete distal suspen- 
sion of the function of the cord does not occur, but 
these cases are so apt to be complicated by partial 
<lestruction of the substance of the cord, or pro- 
nouncetl concussion, that they are difficult to 
diagmose. 

Destruction of the cord may arise either as a re- 
sult of direct injury by a bullet or an indriven bone 
fragment, or may occur as the result of the trans- 
mission of energy from the missile at high velocity 
passing near the cord. The shattering of the cord 
by molecular vibration has been noted by all ob- 
servers as a result of the use of the modern high- 
velocity projectile. It has occurred in cases where 
the bullet barely grazed the membrane of the cord. 
The cord is reduced for some extent to a custard- 
like material, and is completely and permanently 
destroyed, as though it had been severed by a 
missile. 

In cases of involvement of the cord, the deter- 
mination of the exact conditions is often difficult, 
and early in the case it may be impossible. Shock 
is usually marked by paralysis and anesthesia of 
the parts supplied from the cord below the injury, 
parah-sis of the bladder and rectum, and loss of re- 
flexes commonly occur at once, whether the injury 
is a complete destruction of the cord or not. 

The complications and sequelae following in- 
jury to the cord are spinal meningitis, myelitis, 
diseases of the kidney, and bed sores. 

Meningitis and myelitis are usually due to di- 
rect infection, and may be either local or general. 
The general form is quickly fatal. In the degener- 
ative clianges which follow injury without infec- 
tion the course of the case is slower, but the pa- 
tients usually die from the conditions coijnected 
with cystitis, lenal disease and decubitus. 

Treatment. — The treatment of gunshot frac- 
tures of the spine is always difficult unless the case 



THE HOSPITAL BULLETIN 



151 



be one of those simpler forms of fracture without 
involvement of the cord or injury to nerves. The 
threat majority of spinal wounds are made by bul- 
lets, and are deej) and small, making- the determi- 
nation of the amount of injury to the cord very 
difficult. If the bullet has passed through, some 
opinion may be formed from its course, but if the 
bullet is lodged, no such information is possible. 

The depth at which the cord is placed, the mag- 
nitude of the operation required to disclose it, and 
the fatal effects which follow infection of the men- 
inges have all to be considered, and make explora- 
tory or reparative operations possible only in the 
hospital, where aseptic technique can be employed 
and where the necessary time for the operation 
can be given. 

An X-ray should be employed to locate the mis- 
sile, and an exploratory laminectomy may be done. 

In cases of complete division of the cord in bul- 
let or stab wounds, the tissue of the cord on either 
side of the lesion is not as contused as in com- 
plete crushes due to fracture. Hence they are 
more suitable for suture of the cord, which does 
no harm and may help to settle clinically the ques- 
tion of the regeneration of the cord. 

If no operation is done, avoidance of probing, 
cleansing of the wound area, an aseptic dressing 
and treatment of the cord symptoms fulfill the 
indication. 

Braun removed a bullet from within the cord, 
but the system did not respond to the stimulants 
exhibited, and the patient died the same day. He 
was perfectly conscious up to the last moment, and 
there were several respirations observed after the 
action of the heart had ceased entirely. 

In 54 cases of gunshot injury of the vertebrae, 
complicated by traumatic lesions of the cord, 42 
were fatal and 12 partially recovered and were 
discharged with varying degrees of physical dis- 
ability. 

Fourteen cases of contusions and concussions 
fcommotion) are recorded, with a mortality of 
100 per cent. 

The 5.4 cases where injury of the cord is men- 
tioned cannot possibly include all in which that 
complication existed. 

Prewitt collected 24 cases operated on, and 25 
not operated on, with a mortality of 54 per cent, 
in the former and 68 per cent, in the latter. 

Schmidt gives 62.5 per cent, of cures in cases 
operated upon and 24 per cent, in those not oper- 



ated on. These figures speak strongly in favor of 
operation, at least where operation is clearly indi- 
cated. 



rR( )1'1CAL .\RSCESS OF LIVER. 



By G. Y. Massenbukg, 
Senior Medical Student. 



AMEBIC AliSCE.SS. 

Amebic abscess, a complication of amebic dys- 
entery, is a condition rarely found in this climate, 
but is quite common in the tropics ; hence the 
name. Tropical Abscess. 

The abscess may occur during an attack of 
dysentery, or it may follow at any time after re- 
covery from the primary infection. Cases of trop- 
ical abscess have followed an infection two years 
previous. 

The abscess may be situated in any part of the 
liver, but is usually found in the right lobe and 
toward the convex side. As to the position of the 
abscess, so are the local symptoms and signs. Pain 
of a dull, heavy character is first noted occurring 
over the liver area and u])|)er abdomen. y\n ab- 
scess situated in the upper right lobe on jjressure 
upon the right phrenic plexus may give rise to 
sympathetic pain in the right shoulder. .\s the 
abscess develops and approaches the pleura alxive 
or the peritoneum below, so does such ])ain occur 
as is characteristic of pleurisy and ])eritonitis. It 
is only when these structures are involved that the 
pain is severe. 

At about the time of onset or noticeable pain 
there is usually a slight evening rise of tempera- 
ture, preceded by chilly sensation or even a mild 
chill, and followed in the night bv a drenching, 
exhausting sweat. This is usually the character of 
the rise of temperature, but cases at times run a 
subnormal temperature and others run a more or 
less constant temperature. 

The constitutional symptoms are those of a 
tiixeniia: thirst, slight digestive di.sturbances and 
diarrhea are present, but at times, when the ab- 
scess is late in following primary infection, con- 
stipation may exist. There is also quite a loss in 
weight, and the patient becomes quite anemic. 

( )n physical examination the signs depend upon 



15^ 



THE HOSPITAL BULLETIN 



the ])ositioii of the abscess. The usual position is 
in the upper right lobe of liver. There will be no- 
ticed on inspection a slight bulging of the inter- 
costal spaces, pressure will show some tenderness 
over that area, there will be noticed dullness above 
the normal limits. If the abscess be large there 
may be some interference with breathing on that 
side, due to pain from involvement of the pleura, 
also because of the encroachment of the abscess 
upon the lung tissue. When the pleura and lung 
are involved cough is usually present, but no ex- 
pectoration noticed unless rupture has taken place 
into a bronchus, when a dark brown viscid pus is 
discharged. 

If the abscess is in the left lobe or on the mider 
surface of the liver, so are the physical signs. 

The abscess in its downward growth usually 
ruptures into the peritoneal cavity. It may, how- 
ever, rupture into the stomach or any part of the 
intestine. It rarely ruptures through the skin, and 
one case is on record where rupture took place 
into the pericardial sac. 

.•\mebic abscess usually runs a course of a few 
weeks or months, but occasionally it is quite short, 
the ])atient dying in about a week. Some cases 
are very ciironic, running a course of a year or 
more. 

In the diagnosis of amebic abscess it is most im- 
portant to get a good history, and a great deal 
depends on previous attacks of dysentery. 

The ameba are found in the bowel at times, and 
often clinches the diagnosis. 

When the symptom complex seems to be quite 
indicative of amebic abscess, some authorities ad- 
vise probing with an aspirating needle into the 
liver. The point selected is in the mid axillary 
line, lietween the eighth and nintli ribs ; from this 
point the greatest area of liver can he reached, and 
especially the seat of most frequent occurrence. 

Early diagnosis is important if a successful out- 
come is to be hoped. 

The prognosis is very grave, especially so when 
the patient is an alcoiiolic, and where multiple 
aliscesses exist. 

The treatment (prophylactic") must be a bet- 
terment in sanitary conditions. The protection 
of tlie water supply, as tliis is the most frequent 
.source : in siiort, careful guarding against any 
food or substance taken into the digestive tract. 
Prof^liyla.vis as regards the individual must also 
be considered, especially as to those things which 
have to do witli lowering resistance of the liver. 



such as abstinence from alcohol, condiment eat- 
ing. Sudden chilling of the skin must be care- 
fully guarded against, that the internal organs be 
not congested. 

The surgical treatment is to go through the 
abdominal or thoracic wall, following the course 
of a canula that has previously been inserted. If 
adhesion between the parietal and visceral layers 
of the peritoneum have not formed you may sew 
the one to the other and wait 24 hours for ad- 
hesions to form, or gauze may be tightly packed 
between the two layers of peritoneum and the 
further course of the operation pursued. It con- 
sists in going into the abscess with a dull instru- 
ment that the hepatic vessels be not severed, and 
so obviate what might be severe and obstinate 
hemorrhage. Some surgeons emplo\- actnal 
cautery in opening the cavitv. 

The pus is evacuated, Init the cavity not curetted, 
as there is rarely formed an enc\ sting membrane, 
and only liver substance lines the cavity, irrigation 
may be done, and injections of quinine are some- 
times made ; that drug is supposed to be germi- 
cidal to the ameba. Several gauze drains and a 
rubber tube should be left in the wound. It is 
very important that a frequent change of dressing 
be done. 

Another operation is first locating the abscess 
with an aspirating needle, taking it out, the aper- 
ture in skin is enlarged, a tractor with a canula 
about three-eighths inch in diameter is inserted 
and into this is put a piece of rubber tubing tightly 
stretched over a stylet, the tractor and stylet are 
removed, leaving the tube to drain the cavitv. 



Dr. Raljih .'^teiner, class of 1883, of Austin, 
i'ex., was a visitor to Baltimore Septemlier 13. 
lie was interviewed by a reporter on the lialti- 
more American staff, and in the course of the in- 
terview said : 

"I am back in this old town, w hich T have never 
ceased to love, on business for the State. We 
are in need of two steam vessels for the quaran- 
tme service at Galveston, and my mission is to 
secure them here. Texas would be in splendid 
condition except for the partial failure of the 
cotton crop. I liad tholight to raise 800 bales 
this sea.son, but by reason of the (lri>ntli will not 
gather over 400 bales. The whole State is simi- 
larly affected, and our income from the biggest 
source — cotton — is going to be heavily reducecl. ' 



lIUSriTAL BULLETIN 



153 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore. Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore^ October 15, 191 1. 



A GOOD SCHOOL OR NONE. 



The JNIedical School of the LIniversity of Mary- 
land has always maintained a good standard and 
has had a long and honorable career. It has not 
been perfect, nor perhaps has it always been as 
rigid as it should have been, nevertheless it has 
always stood for high ideals and proficiency. It 
is absolutely honest; it does not profess to do 
those things it cannot do, and it does those things 
it professes to do. Some years its record before 
the examining boards has been bad, in other years 
good. In iQio its record as reported was bad, 
though more than usual effort had been made to 
eliminate bad material and to graduate onl)' the 
good. This year we think the record will be 
good. The instruction is good, the examinations 
are sufficiently rigid and are impartial, and stu- 
dents have been turned down with a liberal hand : 
but a system was in existence that to a large ex- 
tent was responsible for our poor showing, viz., 
permitting stutlcnts to have credit for branches 
passed, instead of making them take the whole 
year over when they failed to graduate. In this 
way many men slipped through. This has now 
been stopped ; men are not allowed to carry more 
than two conditions from one class to another, 
and if they fail to graduate and are permitted to 
return they must repeat the whole year. More- 
over, but few will be allowed to return if they fail 
in the senior year. Of the 13 who failed in ii)ii, 
only three will be permitted to return, two witli 
averages over 80 and one a foreigner who coukl 
not express himself well in English. We believe 
this new regidation will pretty well stop the fail- 



ures before the examining boards. Another loop- 
hole has also been closed, that of accepting credits 
from other schools. ITercafter credits will be ac- 
cepted only from creditable schools, and those 
who wish to change from doubtful institutions 
will be required to pass examinations to determine 
their proficiency. The Faculty is determined that 
we shall have a good school or none. 



THE 105TH SESSION. 



After a period of four months' quietude the 
campus of the LIniversity of Maryland is again 
alive with life and animation. The benches in 
front of the old building are again doing service. 
The hilarious voice of the student is again to be 
heard. It is sincerely hoped that the bright faces 
now in so much evidence will not be shrouded 
when next Jime rolls around. We are glad to 
announce to our alumni and friends that the 105th 
annual and consecutive session of the medical de- 
partment is now in full swing, and that all indi- 
cations point to a large attendance and a pros- 
perous )'ear. The enrollment at this time is, in 
fact, larger than on the same date last year. Ow- 
ing to the stringent regulations of the Board of 
Regents of the University of New York, and the 
advanced requirements of the Associations of 
American Medical Colleges, more care than ever 
has been exercised in accepting students from 
other institutions, which, we believe, will result 
in a lessened failure of our graduates before State 
licensing boards. 



DO IT NOW! 



"The days of our )-ears are threescore years 
and ten ; and if by reason of strength they be 
fourscore years, yet is their strength labor and 
sorrow." The writer has not reached the alloted 
threescore \ears and ten, and he never expects, 
by reason of strength, tcj reach fourscore years, 
\et he knows something of both lalxir and sor- 
row. Anyone who undertakes to raise an en- 
dowment fund for a medical school will cer- 
tainly become well acquainted with labor, and 
before he accomplishes his task he is also likely 
to be on intimate terms with sorrow. If the 
writer could live the threescore years and ten in 
health and strength, he is confident that he could 



154 



THE HOSPITAL BULLETIN 



raise the $100,000 needed for the department of 
pathology, but as he has no guarantee that his 
hfe and strength will be spared for that length of 
time, and as the endowment is urgently needed 
now, he begs his friends not to delay sending in 
their contributions. Not to be too lugubrious, 
however, he is pleased to aimounce that the sub- 
scriptions for September were by no means bad, 
and that a substantial addition has been made to 
the fund both in pledges and cash. 

The subscriptions to October i are as follows : 

Robinson bequest $5000 

Dr. Hugh Hampton Young, J. H. U 100 

Dr. S. J. Meltzer, LL.D., New York 10 

Dr. Gideon Timberlake 25 

Mr. H. P. Ohm 10 

Dr. Samuel W. Moore, D.D.S 25 

Thomas C. Basshor Company 10 

Hospital Bulletin 5 

Maryland Medical Journal 5 

Miss C. M. Selfe 5 

Prof. R. Dorsey Coale, Ph.D 100 

Dr. John J. R. Krozer, 1848 50 

Dr. Eugene F. Cordell, 1868 10 

Dr. John G. Jay, 187 1 25 

Dr. Joseph T. Smith, 1872 10 

Dr. W. J. Young, 1872 25 

Dr. Thomas A. Ashby, 1873 100 

Dr. David W. Bulluck, 1873 -lOO 

Dr. Robert Gerstell, 1873 5 

Dr. Randolph Winslow, 1873 100 

Dr. H. T. Harrison, 1874 5 

Dr. John D. Fiske, 1875 5 

Dr. R. H. P. Ellis, 1877 10 

Dr. Charles W. Mitchell, 1881 100 

Dr. L. Ernest Neale, 1881 100 

Dr. E. L. Meierhof, 1881 50 

Dr. J. M. Hundley, 1882 250 

Dr. Henry Chandlee, 1882 10 

Dr. J. C. Perry, 1885 100 

Dr. B. Merrill Hopkinson, 1885 25 

Dr. H. C. Reamer, 1885 10 

Dr. Frank Martin, 1886 100 

Dr. John R. Winslow, 1888 50 

Dr. C. W. McElfresh, 1889 100 

Dr. Saint Clair Spruill, 1890 100 

Dr. Rupert Blue, 1892 100 

Dr. Frank J. Kirby, 1892 50 

Dr. Martin J. Cromwell, 1894 50 

Dr. Ciiarles T. Harper, 1894 50 

Dr. Harry Adler, 1895 lO"^ 

Dr. Jose L. Hirsh, 1895 50 



Dr. Joseph W. Holland, 1896 50 

Dr. R. W. Stnrgis, 1896 2 

Dr. Guy Steele, 1897 15 

Dr. Page Edmunds, 1898 50 

Dr. L. W. Armstrong-, 1900 10 

Dr. S. Demarco, 1900 50 

Dr. M. S. Pearre, 1900 5 

Dr. J. D. Reeder, 1901 50 

Dr. Nathan Winslow, 1901 50 

Dr. Arthur M. Shipley, 1902 250 

Dr. H. C. Davis, 1902 10 

Dr. H. L. Rudolf, 1902 25 

Dr. Hugh Brent, 1903 25 

Dr. G. C. Lockard, 1903 25 

Dr. Geo. S. M. KiefTer, 1903 25 

Dr. H. J. Maldeis, 1903 25 

Dr. Howard J. Iglehart, 1903 25 

Dr. R. C. Metzel, 1904 10 

Dr. Robert P. Bay, 1905 100 

Dr. B. F. Tefft, 1905 100 

Dr. Jos. A. Devlin, 1906 10 

Dr. W. F. Sowers, 1906 25 

Dr. Robt. W. Crawford, 1906 25 

Dr. Leo Karlinsky, 1906 20 

Dr. J. F. Hawkins, 1906 25 

Dr. Frank S. Lynn, 1907 25 

Dr. T. H. Legg, 1907 5 

Dr. E. H. Kloman, 1910 25 

Dr. A. Sagebien, D.D.S. , Cuba 5 

Total $8202 

Additions for the month $..joo. 



ABSTRACT 



The following abstract was taken from the 
Lancet of September 2, 191 1 : 

In the Maryland Medical Journal for July 
Prof. R. Winslow has reported two cases of a re- 
markable injury — complete transverse destruc- 
tion of the spinal cord from a bullet wound with- 
out penetration of the spinal canal. In the first 
case a man, aged 24 years, was shot with a pistol, 
the bullet entering in the left seventh intercostal 
space just behind the mid-axillary line. He fell 
to the ground paralyzed below the umbilicus. 
There was severe pain in the upper abdomen and 
chest. He was taken to the hospital, where he 
was found to be completely paralyzed both in 
sensation and motion up to a line extending 



THE HOSPITAL BULLETIN 



155 



round the body lYz inches under the umbiHcus in 
the middle line in front and curving upward along 
the upper border of the twelfth rib to the spine. 
Above the i>aralyzed region was an area of hyper- 
aesthesia three inches wide. The paralysis was 
of the flaccid type. Cremasteric and slight plan- 
tar reflexes were present, but the patellar and 
tendo-achillis reflexes were absent. He could not 
pass urine and the bowels acted only after en- 
emata. Kernig's and Babinski's signs were ab- 
sent. Complete transverse destruction of the cord 
at the ninth dorsal segment was diagnosed. Ir- 
regular exacerbations of temperature supervened, 
but the general condition was good. A radiogram 
showed the bullet in or about the body of the 
eighth dorsal vertebra. Believing that the spinal 
cord was completely divided, Professor Winslow 
determined to explore the spinal canal, and, if 
justifiable, suture the cord. He removed the 
laminae of the seventh, eighth, ninth and tenth 
dorsal vertebrae. There was no blood in the 
canal and the dura was uninjured. The dura was 
opened widely, permitting the escape of much 
cerebro-spinal fluid. The cord did not appear to 
be altered, though subsequently some grumous 
material escaped from it. There was nothing 
more to do than to close the wound. Healing- 
took place by first intention and the patient was 
neither improved or made worse by the operation. 
The fever continued, he became emaciated, and 
bed sores formed, but he was living at the time of 
the report. 

In the second case a girl, aged i8 years, was 
shot in the left side of the neck. The bullet en- 
tered about the middle of the sternomastoid mus- 
cle and passed downward, inward and backward. 
She fell forward with paraphlegia. paralysis and 
dilation of the left pupil. There was complete 
anesthesia below the first rib of the left and the 
third rib on the right side. Retention of urine 
and feces ensued. The diaphragm was not af- 
fected. Sensation and motion partially returned 
in the left arm. The reflexes were abolished and 
bed sores quickly formed. Bullet wound of the 
second dorsal vertebra, crushing or otherwise in- 
juring the cord, was diagnosed. Death occurred 
on the twenty-second day. The necropsy showed 
that the bullet passed behind the brachial plexus, 
between the anterior and middle scaleni muscles, 
broke the tip of the transverse process of the 
seventh cervical vertebra, penetrated the body of 
the second dorsal, cut a piece from the first rib, 



and impinged on, but did not penetrate the spinal 
canal. Bloody serum in the canal and spinal 
meningitis were present. The cord was not pene- 
trated or compressed, but was disintregated and 
much reduced in size opposite the position of the 
Inillet. In these cases the injuries appear to be 
due to concussion of the spinal cord, though it is 
difficult to understand how complete transverse 
destruction of the cord can occur without direct 
impact. However, its occurrence is recognized. 

During the American Civil War a number of 
such cases was observed. In his "Manual of 
Military Surgery," written for the use of surgeons 
oi the Confederate Army, the late Prof. J. 
Chisolm stated that concussion produced by ex- 
plosion of a shell near the back was not an infre- 
quent injury, and that its symptoms were pain 
and impairment of motion and sensation in the 
lower limbs, amounting at times to paralysis. 
Colonel W. F. Stevenson states in his "Wounds 
in War" that concussion of the cord without frac- 
ture of the spine may be produced by shell frag- 
ments or small arm projectiles, and that paralysis 
below the injury may be absolute, but if second- 
ary changes do not take place in the cord, and 
hemorrhage into the spinal cord does not occur, 
recovery may be rapid and complete. The treat- 
ment of complete division of the spinal cord is 
still a mooted question. Psysiologists declare that 
regeneration is impossible once the cord has been 
divided, but three cases of suture with slight im- 
provement have been recorded by American 
surgeons. The first surgeon to perform the oper- 
ation was Dr. Francis T. Stewart of Philadelphia. 
In a case of bullet wound of the dorsal spine he 
found the cord completely divided with an inter- 
val of three-quarters of an inch between the ends. 
He freshened the edges and sutured the cord with 
three chromised catgut sutures. The patient, who 
had been paraphlegic. soon showed improvement, 
and sixteen months after the operation could per- 
form various movements with the toes and legs, 
and had control over the urine and feces. 



ITEMS 

Dr. John McMullen, class of 1895, Past As- 
sistant Surgeon, U. S. P. H. & M. H. S., is sta- 
tioned in Baltimore. 



Dr. Eugene Hagan Mullan, class of 1903, is 
a member of the LTnited States Public Health and 



IS6 



THE HOSPITAL BULLETIN 



Marine Hospital Service, commissioned as as- 
sistant suro-eon. 



Dr. James A[. Craighill, class of 1882, has re- 
moveil his offices and residence to the W'albert. 
Lafaxette avenue and Charles street. 



The following appear to be the living mem- 
bers of the class of 1873 : 

Thomas A. Ashby, Baltimore, ^Id. 
Benjamin R. Benson, Cockeysville. Md. 
Robert M. Bolenius, Lancaster. Pa. 
David A\'. Bnlluck. \\'ilmington, X. C. 
Truman E. Fairall. Tecumseh, Xeb. 
Mrginius W. Gayle, Kansas City, Mo. 
Richard Gerstell, Keyser, W. \'a. 
Robert Gerstell, Keyser, \\'. \a. 
\\'m. A. Hinchman, McKeesport, Pa. 
Jas. ^^'. Humrichouse, Hagerstown, Aid. 
\Vm. S. Maxwell, Still Pond, Aid. 
T. Morris Alurray, ^^'ashington, D. C. 
Frank \\'. Pearson, Baltimore, Md. 
John H. Rehberger, Baltimore, Aid. 
Charles E. Sadtler, Baltimore, Aid. 
Chas. E. Scholl, Camden, Ind. 
James A. Sexton, Fuqua Springs, X. C. 
Oscar Stansbury, Chico, Cal. 
Frank A. Warner, Baltimore, Aid. 
Randolph Winslow, Baltimore, Aid. 



Alajor William F. Lewis, class of i8()3. Aledical 
Corps, f . S. A., who has recently returned from 
the Philippine Islands, and who has been spend- 
ing a leave of absence in North Carolina, was 
in Washington recently en route to his station, 
Presidio of Alonterev, California. 



Dr. G. Timberlake read a paper before the re- 
cent meeting of the \\"est Virginia Aledical So- 
ciety, September 20, 21 and 22. at ^^'hite Sulphur 
Springs. W. Va. 



Capt. Frank A\'atkins Weed, class of 1903, 
Medical Corps, U. S. A., has been ordered to 
proceed to Manila, P. I., on the transport sailing 
from San Francisco on or about February 5, 
1912. and on arrival will report in person to the 
commaniling general, Phili])pinc Division, for 
assignment to dutv. 



Dr. Charles Thomas Harper, class of 1894, 
who is medical director and owner of the Wil- 
mington Sanitarium, corner Front and Castle 
streets, Wilmington, X. C, writes in reference 
to his sanitarium : "I am thankful to say I have 
met with more than success since its opening. 
I have 15 beds, five nurses and an orderly, and 
have done some very satisfactorv work. It is 
open to the profession, and a few have taken ad- 
vantage of the pleasant surroundings. I wish to 
thank Dr. Randolph Winslow and the stafl' of 
the University Elospital for the courtesies while 
there, and assure them I will call again." 

Dr. Harper's reputation is general in both 
North Carolina and Alaryland, and his acquaint- 
ance with professional men extends throughout 
the South. He was born at Smithville, X. C, 
August ID. 1872, the son of James Thomas and 
Annie S. (Drew) Harper, both of X'orth Caro- 
lina, and descendants of An'^erican ancestors. 
His earlier education was obtained in the public 
schools of Smithville and at Cape Fear Academy 
at Wilmington, and his collegiate education at 
Trinity and Davidson colleges. He afterwards 
entered the University of Alaryland, from whence 
he graduated in 1894. He was interne at the 
University Hospital during his last year at the 
University, and afterwards practiced for four 
vears in Baltimore. He was at that time con- 
nected with the teaching force of both the Balti- 
more University Aledical College (now extinct) 
and the University of Alaryland. He left Balti- 
more in 1898, and took up his residence in Wil- 
mington, where he has become well known. 
Since 1900 he has been superintendent of public 
health of ^^'ilmington. He is a member of the 
Xorth Carolina State Aledical Society, the Han- 
over County Aledical Society and belongs to sev- 
eral fraternal orders, including the Atasonic and 
Knights of Pythias. He is president of the Boney 
& Harper Alilling Co. W'e wish Dr. Harper much 
success with his sanitarium. 



Aliss Henrietta Ashcom Gourley, University 
Hospital Training School for Xurses, class of 
1908. has returned to her former residence, 2128 
St. Paul street. We are glad to report that A'liss 
Gourley has sufficiently recovered her health to 
resume her practice. 



Dr. Samuel A. Stevens, class of 1900, of Alon- 



THE HOSPITAL BULLETIN 



157 



roe, K. C, was a recent visitor to the University- 
Hospital. 



Dr. Page Liinnnids, class of i8()8, has removed 
to the Wentvvorth Apartments, Alnlherry ami 
Cathedral streets, Baltimore. 

Dr. Edmunds, since his graduation, has been 
very successfully engaged in the practice of his 
specialtv — genito-urinary diseases — in Baltimore, 
and has been continuously associated with the 
staff of the l^niversity Hospital. He is at present 
associate in genito-urinary diseases. In 1907 he 
was appointed surgeon to the Baltimore & Ohio 
Railroad, and in 1909 consulting surgeon to the 
same road. He is also surgeon to the ^^'ashing- 
ton, Baltimore & Annapolis Railroad. He did 
post-graduate work in Berlin in 1904. Dr. Ed- 
munds is the son of Dr. Page Edmunds and Susan 
Elizabeth (Cowart) Edmunds, and was married 
to Miss ]\Iillicent Geare, class of 1905, University 
Training School for Nurses, in St. Ann's Church. 
Annapolis, "Sid.. May 30, 1907. 



Dr. Joseph E. Gichner, class of 1890, has re- 
turned from a visit to Germany. This is his first 
visit there since he did post-graduate work at the 
University of Berlin 20 years ago. While Dr. 
Gichner was abroad he met Dr. Ehrlich. the dis- 
coverer of "606." He was extremely interesteil 
in the Hygiene Exhibition, which was in session 
from iNIav I to October i, and draws the follow- 
ing pen picture of it for the Evening Sun in a 
recent interview : 

".V spot as large as Druid Hill Park, occupied 
by many buildings, in which there were shown in 
such popular manner as to inform even the igno- 
rant classes of the progress which has been made 
in medicine and its allied sciences in knowledge 
of clean living as related to health ; Europe, 
Asia, Africa and South America contributing. 

"The United States." said Dr. Gichner, "was 
the onlv one of the family of nations which did 
not have an exhibition there. That points again 
to the need of a national department of health in 
our country. It is preposterous to think of the 
nation whose phvsicians made possible the build- 
ing of the Panama Canal when other nations had 
failed because they could not master the prob- 
lems of health involved in the project, whose 
physicians stamped out yellow fever in Cuba and 



did so much to rid the Philippines of disease, 
failing to exhibit at such a world-congress as that 
at Dresden. 

"The museums and laboratories of the univer- 
sities of the world were searched for the material 
for this exhibition. Imagine a place in which 
one mux wander from a room in which one sees 
illustrated the bearing of objects of Egyptian 
daily life and the ceremonies of burial on the 
health of that ancient people, to another room in 
which is depicted the sources of the pestilences 
of the Middle Ages and the measures which were 
used to tight them ; and then on to other rooms in 
which cuts of diseased meat are dis]jlayed, in 
which the modern housewife is shown how to de- 
tect these diseases on the market stall, in whicli 
she is shown how to cook and dress a joint of 
beef in order to get the greatest food value from 
it ! The relations of clothing, housing and of 
occupations to health were shown in equally 
graphic manner. Superstitions in regard to dis- 
ease, the belief that amulets and charms would 
ward otT ailments, were ridiculed in the exhibits 
in a manner which could not fail to impress the 
people. 

"The temperance question was not neglected. 
There is in Germany a distinct tendency to curb 
the drinking habits of the students and the peo- 
ple in general. There are many temperance so- 
cieties in the empire, as there are here, but many 
are merely temperance, not total abstinence, so- 
cieties. The effects of alcohol on the human 
bod^' were shown." 



Dr. James Hugh Bay, class of 1908. has been 
appointed by the Postofifice Department as exam- 
ining physician to the Civil Service Board of Ex- 
aminers for Havre de Grace, Md. 



Dr. J. Francis Byrne, class of njio, is con- 
nected with the experimental department of 
Parke, Davis & Co., and is residing at 132.-1. 
McCulloh street. 



Dr. Richard C. Dodson, class of 191 1, is lo- 
cated at the .\tlantic Coast Line Hospital, ^^'ay- 
cross, Ga. 



Dr. Arnold Dwi.glit Tuttle. class of igo6, is 
located at the ,\rmv General Hospital. San I'Van- 
cisco, Cal. 



ISS 



THE HOSPITAL BULLETIN 



Dr. O. S. Gribble, class of 1904, is located at 
Beverly, W. Va. 



Dr. Charles W. McElfresh, class of 1889, has 
removed to the Cleveland, 1415 Linden avenue, 
Baltimore. 



Amongst our alumni located in Georgia are the 
following : 

J. L. Rile\', '05, 295^ ]\Iarietta avenue, Atlanta. 

Herbert Jerome Rosenberg, '08, Henry ^^'. 
Grady Memorial Hospital, Atlanta. 

Julian P. Ilarrell, '06, 713 Egmont street, 
Brunswick. 

Edgar B. Davis, '04, Byromville. 

William A. Chapman, '8j, Main street, Cedar- 
town. 

James H. McDufifie, '87, 1206 Second avenue, 
Columbus. 

Wm. Benjamin Warthen, '05, Davisburo. 

Harlan L. Erwin, '04, Spencer street, Dalton. 

Nathaniel L. Spengler, '03, Donaldsonville. 

Chas. Wesley Roberts, "06, Douglass. 

Joshua B. Walker, "go, Dudley. 

Edwin J. Dorminy, '90, Fitzgerald. 

Henry Latimer Rudolph, '02, 44 N. Greene 
street, Gainesville. 

Virgil E. Franklin. '96, Graymont. 

H. J. Erwin, '04, Hamilton. 

Elijah S. Peacock, '91, Harrison. 

Samuel T. R. Revell, '05, Broad street, Louis- 
ville. 

JeflFerson D. Wright, '82, Broad street, Louis- 
ville. 

Jos. W. DuGuid, '93, 519 Forsyth street, 
Macon. 

Weenes R. Winchester, '74, 610 Mulberry 
street, Macon. 

J. D. Malone. '84, ^ilalone Building, Marietta. 

Samuel S. Gaulden, '86, Walker Building, 
Quitman. 
~J. A. Bussell, '88. Rochelle. 

Chas. D. McRae, '88, Rochelle. 

Wm. Rawlings, '75, Sandersville. 

Craig Barrow, 1900, 26 Liberty street. Savan- 
nah. 

Raymond ^^ Harris, '07, Savannah. 

S. Latimer Phillips, '85, 232 Bull street. Sa- 
vannah. 

Harry Young Righton, Jr., '07, 12 Jones 
street W., Savainiah. 

F. A. Blackwell, '05, Tignall. 



Dr. William Dodds Scott, Jr.. class of 1904, 
who has been engaged in Baltimore in the prac- 
tice of genito-urinary diseases since his gradua- 
tion, has removed to Cambridge, Md., where he 
will enter general practice. Dr. Scott was promi- 
nent in his student days as an athlete, and was 
very much beloved by the student body. For one 
year after graduation he occupied the position of 
assistant resident surgeon in the University Hos- 
pital, since which time he has been connected 
with the Genito-urinary Department of the Uni- 
versity of J\Iaryland, at the time of his resignation 
holding the position of associate in this depart- 
ment. For the past 18 months Dr. Scott has been 
connected with the Dispensary force of the Johns 
Hopkins Hospital in the Department of Genito- 
urinary Diseases. The Bulletin joins his many 
friends in wishing him much success in his new 
field. 



Miss Frances Robey, member of one of the first 
classes to be graduated from the University Hos- 
pital Training School for Nurses, is ill with 
tvphoid fever. 



BIRTHS 

Dr. Robert L. Mitchell, class of 1905, and Mrs. 
Mitchell, 2112 Maryland avenue, have announced 
the birth of a son, Robert Levis Mitchell, Jr. 



MARRIAGES 



Dr. Frederick Henry Herrman, class of 1907, 
of 3115 East Baltimore street, and Miss Minnie 
Heed, daughter of 'Sir. and Mrs. Charles Heed, 
of 16 South Patterson Park avenue, were married 
on Tuesday, October 3, at Alexandria, Va., by 
Rev. George F. Flyde. Dr. Herrman and Miss 
Heed first met five years ago when members of 
the same Sunday-school. They were accom- 
])anied on the trip to Alexandria by Mr. and Mrs. 
Rennenberg, a brother-in-law and sister of the 
bride. The honeymoon was spent in New York, 
and a reception was ,^iven the bride and groom 
upon their return to Baltimore, October 7, at the 
home of the groom's parents. Dr. Herrman spent 
si.x months after graduation as assistant surgeon 
in the Hebrew Hospital. He is well known in 
East Baltimore. 



Dr. Benjamin Robert Benson, Jr., class of 
1907, of Cockeysville, Baltimore county, Mary- 



THE HOSPITAL BULLETIN 



159 



land, was married to Miss Elsie Bartlesoii, 
daughter of Mr. and Mrs. Hilberd E. Bartleson 
(if Cockeysvillc, on Tuesday afternoon, Uetobcr 
10, 191 !, at 3 o'clock, at the Sherwood Protestant 
Episcopal (Jhurch. The couple will be at home 
after November i. 



iJr. Arthur lllakc Clarke, class of 1906, of 
Planlersvillc, S. C, and Miss Mary A. Bath, also 
of Plantersville, were married in Charleston, S. 
C, on Tuesday afternoon, August 22, by the Rev. 
W. H. Murray. Dr. Clarke is a native of Can- 
ada. Since entering upon practice in South Caro- 
lina he has built up a fine practice and reputation 
in the section where he makes his home. He is 
regardetl as a physician of lirilliant attainments. 



DEATHS 



It is with the deepest regret that we announce 
the death of ^Irs. 2^Iinna Howison Coale, wife of 
Dr. R. Dorsey Coale, dean of the Medical Depart- 
ment of the University of Maryland. 

]\Irs. Coale was operated on for appendicitis 
on Monday last at the L^niversity Hospital, and 
at first the operation was thought to be successful, 
but Mrs. Coale died on Friday, October 6, 191 1, 
at 6 P. M., of heart failure. 

She was the daughter of the late Capt. John 
W. Howison of the Ignited States Revenue Cut- 
ter Service, and was born in New Bedford, Mass., 
37 years ago. She came to this city with her 
parents when quite a small child, and was edu- 
cated at Notre Dame. She met Dr. Coale while 
visiting her uncle. Dr. Rohe, while still a pupil at 
Notre Dame. She was a descendant of the Cof- 
fins of Nantucket, one of the oldest and most 
prominent families of New England. She is sur- 
vived by her mother, Airs. J. W. Howison, and 
one sister, Airs. Leslie Witherspoon of Chicago. 

Mrs. Coale was a woman of engaging person- 
ality, and beloved b_v all who were so fortunate 
as to know her. She was an expert horsewoman 
and was frequently seen on tlie many drives 
around Baltimore. She was a member of the 
Colonial Dames, and was prominent socially. She 
was considered one of the most beautiful women 
in Baltimore, and will be nntch missed in many 
circles in Baltimore. 

Mrs. Coale was buried from her home, 17 West 
Mt. Royal avenue, Alonday afternoon, October 9, 



11)1 I. ( )nly the members of the family and a few 
close friends were present. Rev. William A. Mc- 
Clenthen of Alt. Calvary Protestant Episcopal 
Church, conducted the services. Burial was in 
(jreenmount Cemetery. Out of respect to Mrs. 
Coale's memory, lectures were suspended in the 
Medical Department of the University the day of 
the funeral. 



As we go to press we learn of the death of Dr. 
John Reese Uhler, class of 1861, of 1531 AIcCul- 
liih street, Baltimore, after an illness of two years. 



Dr. William Worthington Hopkins, class of 
1858, died at his home. Cover's Hill, near Havre 
de Grace, Aid., August 4, 1911, after a prolonged 
illness. He was the son of the late Dr. Thomas 
C. Hopkins, class of 1830. Dr. Hopkins was well 
known and much beloved all through Harford 
county. He was buried on August 6 from Grace 
Protestant Episcopal Church, Darlington, Md., 
interment being in Darlington Cemetery. He is 
survived by his widow, who was critically ill at 
the time of his death, and a son and daughter. 



Dr. Joel ^^'. Nixon, class of 1878, died suddenly 
at his home, 5455 Page avenue, St. Louis, AIo., 
on August 25, 191 1. 



Dr. Joseph Penn Chancy, class of 1852, died 
recently at his home at Breathedsville, Washington 
county. Alary land, aged 81 years. Dr. Chaney 
was educated at Alarshall College, Alercersburg, 
Pa., and at the University of Alaryland. The 
Chaney family is of French origin, and went to 
England with William the Conqueror. Dr. 
Chaney began the practice of medicine in Funks- 
town, and later removed to Breathedsville. He 
retired in 1890. and since has devoted his time 
to farming. His wife was Miss Maria Van Lear, 
a granddaughter of Ala j or Van Lear, a member 
of General Washington's staff. She died eight 
years ago. He is survived by two sons — Bar- 
tholomew v. L. and Eastburn Chaney, and four 
daughters — Airs. Harvey Dillenger of Williams- 
port, Aid., and Alisses Eno, Sadie and Minna 
Chaney. 



ATiss Gray, a pupil nurse in the University 
Hospital Training School for Nurses, died at the 



i6o 



THE HOSPITAL BULLETIN 



University Hospital September 13, 191 1, from 
typhoid fever. 



Dr. Luther M. Zimmerman, class of i8('J4, a 
well-known physician and druggist of Hagers- 
town. Md., died at his home, 699 S. Potomac 
street. Wednesday, September 13, 191 1. after a 
prolonged illness, aged about 70 years. Dr. Zim- 
merman was born near Woodsboro, Md. He was 
educated at Pennsylvania College, Gettysburg, 
Pa., and also graduated from the medical depart- 
ment of the LTniversity of Maryland. He served 
as surgeon in the LTnion Hospital at New Orleans 
for six months during the Civil War. He prac- 
ticed medicine at Westminster, Johnsville and 
Meyersville, remaining at the latter place about 
30 years. In 1898 lie moved to Hagerstown, and 
in addition to his practice opened a drug store. 
He practiced until about a }ear ago. when, owing 
to physical disability, he gave up both his practice 
and drug store. 

Dr. Zimmerman was a member of St. John's 
Lutheran Church, and until a year ago taught a 
class in the Sunrlay-school connected with this 
church. He was a life-long Republican, and for 
a number of years served as postmaster at 
IMeyersville. He was buried on the Friday fol- 
lowing his death in the family lot at Woodsboro. 
He is survived by a widow and five children, the 
latter being Rev. H. E. Zimmerman. New Haven. 
W. Va. ; H. C. Zimmerman, Philadelphia ; Mrs. 
W. R. Harp, Hagerstown,; Miss Cora and Miss 
Edith Zimmerman, at home. 



LABORATORY REPORT OF THE UNI- 
VERSITY I-IOSPITAL. 
Month of August. 

Blood E.vaiiiiiiatioiis. 

Leucocyte counts 167 

Erythrocyte counts i^y 

Differential leucocyte counts 14 

Hemoglobin determinations 68 

Smears for malarial parasites 13 

Blood cultures 10 

Wasserman 14 

Widals 89 

41^ 

Urine Examinations. 

Routine urinalysis (chemical and micro- 
scopic) 341 

341 



2J iscclliiiicous. 
Gastric contents (chemical and micro- 
scopic) 15 

Feces ( macroscopic. niicrosco]MC and some 

cases chemical examination ) 10 

Sputum examination 25 

Bacteriological cultures and smears. ... 24 

Examination of ascitic fluid 2 

Sections of tissue for microscopical ex- 
amination 25 

lOI 

Total 854 

]\IoNTH OF September. 
Blood Examinations. 

Leucocyte counts 210 

Erythrocyte counts 68 

l^ifl:"erential leucocyte counts 20 

Hemoglobin determinations 80 

Coagulation time 2 

Smears for malarial parasites 30 

Blood culture 5 

Widals 83 

Wasserman t8 

516 

Urine Examinations. 

Routine urinalysis (chemical and micro- 
scopic) 380 

Total estimation for chloride i 

Total estimation for urea i 

382 

Miscellaneous. 

Gastric contents (chemical and micro- 
scopic ) 18 

Feces, etc 6 

Sputum examination 22 

r>acteriological cultures and smears. ... 28 

\'accines 4 

Examination of spinal fluid i 

Examination of hydrocele fluid i 

Sections of tissue for microscopical ex- 
amination 17 

Autopsies I 

98 

Total 996 

Dr. J. L. HiRSii, 
Dr. II. J. Maldeis, 
Dr. L. K. W.xlker, 

.'\. G. M.VRTIK, 

T. D. SuAur. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Posi-omcc 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., NOVEMBER IS, 1911. 



No. 9 



.\ iil:rr]ed trip through el'ROPe. 



By T. A. Ash BY, M.D. 



(Continued from October 15//; Issue.) 

On our arrival in Interlaken at 9.30 P. M. 
o'clock we found pleasant rooms in the Royal St. 
George Hotel, .\fter a continuous ride of 13 
Iiours from Paris, it seems needless to say, we 
were both tired and hungry. .A. good supper 
tjuickcned our energies and gave us a spirit for 
sightseeing. \\'e started out on foot to see the 
cit_\', Ijrilliantly illuminated with electricity and 
alive with crowds of people visiting the cafes, 
parks and casinos. Bands of music were giving 
outdoor concerts, various places of amusement 
were open to inspection, and a merr}- crowd of 
men, women and children was promenading the 
streets or seated around tables enjoying refresh- 
ments and drinks. 

The place was filled with tourists and summer 
visitors, all bent upon sightseeing and pleasure. 
For over two hours we took in all that could 
be seen during that time and then returned to 
our rooms for a night's rest. When I arose from 
my bed the following morning, the first objects 
my eyes met were the tall peaks of the Jung- 
frau, covered with snow, seventeen miles distant, 
towering over 13,000 feet into the heavens. 
This view from the window of my room was 
the most beautiful and impressive I have ever 
witnessed. The snow-capped mountains all 
around were in striking contrast with the green 
fields and growing crops in the vallevs below. 
The temperature in Interlaken during our stay 
there was uncomfortably warm, whilst in the 
higher altitudes into which the peaks of the Alps 
reached we had a perfect object lesson of smnmcr 
and winter temperature in close proximity. 



After breakfast Air. Page and I took a victoria 
and were driven all over the city and surrounding 
suburbs. Interlaken is situated in a level valley 
surrounded almost entirely by lofty mountains. 
It is located on the banks of a rapid and bold 
stream of water which carries the waters of Lake 
Brientz into Lake Thun, the distance between the 
two lakes being about one mile. The main street 
of the city runs parallel with the river the entire 
distance, whilst the large hotels anfl casinos face 
on the street, with large parks and grounds ex- 
tending back to the river. ( )ther sections of the 
street are lined with ponceons, stores, bazars and 
eating-houses. The hotels are large and beauti- 
ful structures and give accommodations to large 
numbers of tourists and summer guests. In fact, 
the residential population is very small during the 
winter months and the place is almost abandoned. 
During the summer season thousands of people 
tlock to the place and the hotels, ponceons and 
boarding houses are filled with visitors from all 
parts of the world, who come to see the lake 
and mountain scenery and to enjoy the pleas- 
ant summer climate. Everything is done to 
attract and entertain the visitor. I saw no at- 
tempts to impose upon one and was struck with 
the very moderate prices of living and with the 
courtesy of those who had goods to sell. I made 
a number of small purchases and found prices 
lower than in other cities in Europe. 

In the afternoon we tmik a funiculaire, a small 
car draw by cable, and were lifted up a high 
mountain some five thousand feet to a summer 
cafe, known as Harder Kulm. From this point 
the view was magnificant, a perfect panorama of 
mountain, valley, lake autl city was spread before 
the eye, giving a picture of such rare and ex- 
tended view as to crowd the mind with awe and 
admiration. Nature and art seemed to be liold- 
ing truce, and contending for supremacy. It 



1 62 



THE HOSPITAL BULLETIN 



would be difficult to say whether the wilduess and 
grandeur of nature improved by the art of man 
would have been more impressive without arti- 
ficial aid, or whether the effect had been so en- 
hanced by human eft'ort as to make the whole 
a more perfect picture. This beautiful Alpine 
scenery owes so much to the toil and ingenuity 
of man that one is carried away by the effect. 
Magnificent roads and drives, beautiful villas and 
hotels on lofty plateaus and mountain peaks, steep 
mountain sides cleared of timber and green with 
pastures, fields of growing crops, lakes with 
steamers and sailboats, railroads and cars running 
through valleys or canyons, or over the highest 
mountain passes, all demonstrated the power of 
man to subdue nature and improve upon her 
works. 

I am inclined to think that the great beauty 
of Alpine scenery is made more noticeable by the 
decorations which man has given to it. Take 
away from this scenery the background which 
the roadways, railways, bridges, cities, villages 
and cultivated lands give to it, and we find that 
we have in Canada, Alaska, and in some of our 
Western States, mountains higher and grander 
than any in Switzerland ; glaciers and ice-fields 
that will dwarf anything in Europe. In this 
country everything is in the wild ; man has done 
nothing to bring these great natural wonders 
into general notice or to make them accessible to 
the average traveler. 

On Sunday afternoon we took a railway train 
which carried us some 17 miles through narrow and 
deep canyons to the foot of the Jungfrau. Leav- 
ing the car we entered a funiculaire, and were 
lifted some 5000 feet to a plateau on the moun- 
tain, where we again took an electric road which 
wound round the mountain side the distance of 
a mile to a summer resort known as Miirren. 
This place is separated by a canyon from the 
Jungfrau, one mile distant, with her jjeaks 
white with snow, now standing out and reaching 
up over 13,000 feet. The view of the Jungfrau 
was grand and inspiring. It was well worth the 
long and dangerous climb we had to see it. 
Whilst standing in the depot at ]\Iurren I met 
several ladies who lived ne.xt door to my home 
in Baltimore. They were resting for the summer 
in one of the hotels at Alurren. T am sure w'e 
were mutuallv hai)i)y dver such an imexpected 
meeting. We had also the good fortune to meet 
several Baltimore friends who were boarding in 



Interlaken. I know of no pleasure so satisfac- 
tory as to run across one's friends in a foreign 
country. 

We took a steamer Monday morning at Inter- 
laken and were carried across lake Brientz to 
the landing, some 10 miles distant. Here we 
again took the cars and were carried over high 
mountain rages to Lucerne. The ascent of the 
mountains was so steep that the locomotive was 
compelled to use a cogwheel and third rail to 
climb up the grade. Progress was so slow that 
it took nine hours to go from Interlaken to 
Lucerne, a distance of some thirty miles. The 
view of the country through which we passed 
fully compensated us for the tediousness of 
travel. High mountains, valleys, lakes and bold 
streams of running water all subdued and utilized 
b\- man, made a picture of great beautv to the 
tourist. Everywhere the landscape was dotted 
with towns, villas, factories, farmhouses, hotels 
and cultivated fields. Almost every acre of 
ground seemed to be used for the service of man. 
so diligently have the people of Switzerland im- 
proved their lands and homes. 

We reached Lucerne at 6 o'clock in the after- 
noon and found accommodations at the Hotel 
Mctoria. As soon as we could wash up and 
make a few changes in our clothes we secured 
a cab and started out to see the city before dusk. 
A drive of some two hours gave a fairly good 
view of the city. Among the many curiosities 
of Lucerne is an old tower, situated at the point 
where the River Reuss issues from the Lake of 
Lucerne, which is said to have been a light- 
house in Roman times, and hence gave the name 
to the town. We also saw the celebrated Lion 
of Lucerne, hewn out of the solid rock by Thor- 
waldsen, a monument to the Swiss Guard which 
perished at the Tuilleries in 1792. Lucerne is 
a ]5lace of some 35.000 resident population, which 
is more than doubled during the summer season 
by visitors and tourists. It contains many large 
and handsome hotels, which were filled at the time 
of our visit. These hotels, for the most part, 
arc located on the lake front and are surrounded 
with handsome parks, drives, and walks. After 
dark these places were brilliantly illuminated and 
thousands of people were parading along the 
walks and lake front. The hotels were also filled 
with handsomely dressed men and women, the 
representatives of numerous nationalities. Large 
rooms were filled with roulette tables and other 



THE HOSPITAL BULLETIN 



163 



gaining devices, where men and women were 
betting heavily on the fall of the cards or the 
turns of the wheel. The excited crowd was 
so intent upon the chances of fortune and stood 
so packed around the tables that the looker- 
on had few opportunities to observe the result of 
the games. 1 was surprised to see so many 
handsomely dressed women at these gambling- 
tables. The\' seemed to outnumber the men and 
were bold bettors. Is this an indication of the 
role the modern and ui)-to-date woman is going 
to assume when woman suffrage becomes uni- 
versal ? Does not the commercial spirit tend to 
lower rather than to elevate the standard of 
womanhood? If women are to become com- 
]ietitors of luen in all lines of barter and trade, 
in vote-getting and office-holding, in the govern- 
ment of municipalities and States, is there any 
less reason to expect her as a competitor in 
gaming and horse-racing? These are practical 
(juestions which all thinking and self-respecting 
women should ask themselves. We know the 
innate depravity of man, his love of hazard anil 
chance, his downward tendencies, and have in the 
past depended largely upon the purity and 
righteousness of womanhood to correct his errors. 
If his best guide and helpmate is going to com- 
])ete with him in his lower vices, what help is there 
for a better social life and race development? 

Lucerne is certainly a most beautiful city, a 
great summer resort for the rich and the gay, for 
the upper strata of society where wealth and dis- 
])la_\' have full sway. A stav over night was 
enough to satisfy our curiosity. We left at 8 
o'clock Tuesday momin,g for a tour down the 
Rhine. We traveled by rail from Lucerne to 
Basle, where a change of cars was made. From 
I'lasle we went to Maintz, on the Rhine, where 
the night was spent. The all-day ride from Lu- 
cerne to ^laintz was through Swiss and German 
territory. The day was exceedingly wariu and 
the country was so dry and parched that we have 
no pleasant recollections of this part of our trip. 
I saw little in the farm lands or in the towns 
and cities through which we passed to create good 
impressions. After reaching Maintz we stopped at 
the Rheinlander Hof, which faces a broad avenue 
on the bank of the Rhine. In the evening we 
visited a large park near the hotel, which was 
filled with small tables and chairs occupied by 
several thousand people — men, women and chil- 
dren — all seated around the tables drinking beer. 



wine, soft drinks, and many taking an evening 
meal. A band in a large covered stand was 
rendering operatic music of a very high order. 
In fact, the music was about the best we heard 
in Europe. These people were very happy and 
well-behaved, representing the middle and higher 
classes of society. They were eating, drinking and 
luaking merry with laughter and clapping of 
hands over the performances of the band. This, 
I understood, was a fair example of the evening 
life of the derman people. There was nothing 
immoral or vulgar in the crowd, but a suggestion 
of a refined, amiable and cultivated people. 

On \\'ednesday morning at 9 o'clock we went 
aboard a large steamer for a day's ride down the 
Rhine. The steamer was loaded with passengers 
representing many different countries and lan- 
guages, all, like ourselves, tourists bent on sight- 
seeing. The day was clear and the temperature 
moderate, so that everything seemed propitious 
for an enjoyable passage down this historic river. 
The Rhine, as all must know, has its sources 
in the mountain snows of Switzerland. These 
melted snows pour down into the Swiss Lakes, 
which act as huge reservoirs connected by run- 
ning streams until they unite to form the Rhine. 
The river then flows north through Swiss and 
German territory until it reaches the lowlands 
of Holland, where its course is diverted westward 
by north until it empties through numerous chan- 
nels into the German ( )cean. 

The volume of water is enormous, and its 
variations are very slight. \\'here we took the 
boat at Maintz the river is some 600 yards wide, 
and its depth sufficient for large vessels drawing 
from 10 to 12 feet. The current, I should judge, 
averages from four to six miles an hour, and at 
several places was much more rapid. The Rhine 
at Maintz is about the same size as the Missis- 
sippi at St. Louis at mean water gauge, but differ- 
ing from the latter in the clearness and purity 
of its waters. Since the time of Julius Caesar 
the Rhine has figured more largely in history than 
any of the rivers of the world, not excepting the 
Nile. It has been written up in song and story, 
in romance and history, in war and conquest, 
and in all the arts of husbandry and social life. 
Its vine-clad hills and ruined castles bear witness 
to its present prosperity and to its departed glory. 
As a route of travel, as an avenue of commerce, 
its waters today bear more people and more 
freight than any river of its length in the world. 



164 



THE HOSPITAL BULLETIN 



A ride down the Rliine is, therefore, a pleasure 
greatly sought, and an enjoyment which one 
nuist experience to full}- appreciate. The banks 
of the river from Maintz to Cologne are lined 
with riprap, stone or concrete walls. There are 
no trees on banks to obstruct the view, but the 
farmlands, villas, towns and cities are in full dis- 
play, giving an endless variety of scenery and 
beautiful sights. The upper portion of the river 
passes through a level and gently rolling land- 
scape ; many beautiful villas and private resi- 
dences, splendid farmlands and vineyards line 
both banks. When LSingen is reached the river 
winds its way through high, towering mountain 
peaks, with sides covered with terraced vineyards 
and tops crowned with the ruins of ancient 
castles. 

Bingen has been immortalized by the beautiful 
poem of Mrs. Norton. Many will recall the story 
of the soldier dying in Algiers, who said to his 
companion : 

"Take a message and a tcken to some distant 
friends of mine. 
For I was born at Bingen, at Bingen on the 
Rhine." 

The many ruins of ancient castles standing as 
lonely sentinels overlooking the river recall the 
times when feudal lords and robber barons held 
possession of this country and ruled with blood 
and terror, .^s these old relics of a barbarous 
age came into view, T could not help contrast our 
peaceful ride down the river with the days long 
gone by. when war and pillage made these old 
ruins the only safeguard against savage and 
brutal man. Could they but speak, what a story 
of strife and beastly passion would be related to 
the present tourist ! 

I was surprised at the extent of the commerce 
of the river. Every few minutes we were passing- 
tugs ]jnlling large barges loaded with coal, tim- 
ber and other articles of freight. Hoth banks of 
the river were lined with double-track railroads, 
which were kept busy with long trains of cars 
carrying freight and passengers u]) and down the 
stream. There was a hustle and activity both 
on land and water whicli one never sees on the 
waterways of our cnuntr\-. 

\N'e arrived at Cologne at 5 n'clock in tiie after- 
noon, having been some nine hours on the Rhine, 
tlie distance covered being some hundred miles. 
^Vfter landing we were driven to the Hotel Dom, 



where comfortable rooms were secured. This 
hotel is located on the square just across the 
street from the Cathedral. This gave us the best 
opportunity to see and study the proportions and 
design of this great work of art, a structure of 
such collossal size and architectural ornamenta- 
tion that it stands among the great Cathedrals of 
the world, if not in the first place. Notre Dame, 
in Paris, and the Cathedral in Milan are gener- 
ally regarded as its chief rivals. 

The chief attraction in the Cathedral in Cologne 
is its antiquity and the richness of its carvings, 
ornamentations and artistic finish. As a work of 
art, it deserves the first place, as its symmetry, 
classic design, richness in decoration and statuarx- 
are marvels of architectural skill and labor. 

The first Cologne Cathedral was located on tlu* 
site of the present Cathedral in the ninth century 
by Hildebold. and was completed under Willi- 
bert in Sj^. This building was destroyed by the 
Normans, but was later rebuilt, and Willihert was 
buried in its walls. Over three centuries later 
the Cathedral was destroyed by fire. In 1248 the 
foundation stone of tlie present edifice was again 
laid, but it was not tmtil 1.^22 that the choir was 
consecrated. After another century, 1437, the 
southern tower was so far completed that bells 
could be hung, h'rom this lime on the progress 
of the building was not only suspended, but its 
beauties were often destroyed during the wars in 
which ( iermany was engaged. In 1816, under the 
l)atronage of Frederic William III, a review of the 
plans and reconstruction of the Cathedral took 
place, which led to the final completion of the 
present edifice in 1880. Centuries of time and 
vast sums of money have been used in the con- 
struction of this great monument of architectural 
skill. Like most cluirclus huilt in the middle 
ages, the Cathedral is a cruciform structure, 
composed of a nave. Hanked with double aisles 
and a transce])t wilh single aisles. The two nuter 
aisles do not extend the entire length, but termi- 
nate at the choir, and receive their continuation 
in ninnerous chapels surrounding tlie choir. The 
great beauty and grantleur are derived from the 
towers of four stories, with crowning spires 
reaching a height of 507 feet. In these towcr^- 
and spires are hung the great bells. The soft and 
sweet notes from the great bells are heard at fre- 
(|uenl intervals during the <lay. In the early 
morning I was aroused from sleep by the music 
of the Cathedral bells, and never in mv life Iiavr 



THE HOSPITAL BULLETIN 



i'i5 



1 heard such sweet sounds. They still ring in my 
cars. I feel that I would be willing to make an- 
other visit to Cologne to hear the ringing of its 
great bells, so deep and lasting is the impression 
made on my mind. 

During our short stay in Cologne we again 
made use of the cab to see the city. We rode 
through its great streets and avenues and saw 
many of its public buildings and private resi- 
dences. Tt certainly is a very beautiful place, and 
for its size compares with Paris, London and P>er- 
lin in its architecture, streets and business enter- 
prises. Cologne has about the same population 
as I'.altimore, but it will take the latter city many 
years to catch up with Cologne in good streets, in 
handsome buildings and in business enterprises 
and thrift. 

I was greatly impressed with the enormous 
steel bridge crowning the Rhine at Cologne. I 
should say that it is larger than any of the bridges 
expanding the Mississippi at St. Louis and as 
large and imposing as the great bridge connect- 
ing New York and Brooklyn. 

We left Cologne at 3 o'clock Thursday after- 
noon for Brussels, arriving at the latter place at 
7 o'clock. The ride through that part of Germany 
and IJelgium did not create much enthusiasm. 
The countr\- is rolling, and in places rough, not in 
high state of cultivation and lacking in general 
attractiveness. As we came near to Brussels 
the farmlands were neater in appearance and were 
better cultivated. The Dutch farmhouses and 
outbuildings assumed the character of the Dutch 
farmer. They were neat and old-fashioned, ugly 
and crude. The windmill came in evidence as a 
motive power, and seemed to be doing work when 
the wind was blowing. 

Brussels was brilliantly lighted when we step- 
ped from the car to the depot. We were driven 
to the Hotel Metropole, where we found good 
accommodations. After a substantial dinner we 
walked around the city for several hours and had 
a fair view of the business sections. 

Brussels is better known to Americans as a 
place where carpets and laces are manufactured. 
In history it is better known as the great capital 
of the Dutch Republic and as the battleground 
where religious liberty had its birth and first great 
triumph. Of the modern city I shall have little 
to say. Of its history and people much can be 
said to interest every student and thoughtful per- 
son interested in the growth of civilization and 



an observer of the progress which man has made 
in political and social government. The vast 
plain of lowlands e.xtending from the Cral Moun- 
tains to the German Ocean is occupied by the 
countries once called the Netherlands, now known 
as Belgium and Holland. This country is sur- 
rounded by France, ( iermany and the ocean. This 
low country has been cut into numerous sections 
by the rivers Rhine, Meuse and Sclield, which 
for ages have deposited the debris brought down 
from the highlands among the sand banks thrown 
up bv the ocean around their mouths. By dikes 
and canals the inhabitants of these low countries 
iiave redeemed from the ocean and estuaries of 
these rivers much of the land now making Hol- 
land and the lower parts of Belgium. Here we 
have the best illustration of the thrift and indus- 
try of man in land building, in home build- 
ing, in government building and in all the 
arts of commerce and trade. The first notice 
we have of these people, whose descendants 
now make the great Dutch nations, is given by 
Julius Caesar. In his time hordes of savages 
lived in the swamps and thickets, now the richest 
agricultural section of the world. Under the 
Romans the native tribes w-ere held in subjection 
for several centuries. They were a brave ami 
high-spirited race, and for the next fourteen or 
fifteen centuries were contending among them- 
selves and with neighboring races for freedom and 
liberty of conscience. 

Ethnographically, the people of these low coun- 
tries belong both to Gaul and German}'. In the 
centuries which have passed the Gallic and Teu- 
tonic blood has so mixed that the Dutch race 
has been evolved, a race so distinct intellectually, 
morally and physically as to give it a racial stand- 
ing among the great nations of the world. The 
steps by which these Dutch people have climbed 
into the front rank of civilization illustrate their 
high order of intelligence and moral force. They 
have had in all the centuries past a love for liberty 
and self-government, a hatred of tyranny and op- 
pression. These passions have dominated everv 
action and have led to many wars and revolts. 
The Netherlands have been ruled by the Franks 
under Charlemagne, by the Austrians under Max- 
imilian, by the Dukes of Burgundy under Philip 
the Good, Charles the Bold and Philip the Fair, 
and by Spain under Charles the Fifth and Philip 
the .Second. Whilst nominally governed by for- 
eign rulers they grew in wealth and population, 



i66 



THE HOSPITAL BULLETIN 



and early became the richest and most cultivated 
people of Europe. By industry and thrift they 
built up large and beautiful cities, opened up a 
commerce which carried their manufactured prod- 
ucts to every part of the known world and estab- 
lished prosperous colonies among distant peoples. 
These Dutch people early recognized the advan- 
tages of education and moral culture. Their 
schools and imiversities were amongst the best 
in Europe : their artists rivaled those of the best 
Italian schools and surpassed the other nations. 
\\'hen the doctrines of Protestantism imder 
Luther spread over Northern Germany, the Dutch 
people were among the first to absorb the prin- 
ciples of religious freedom and toleration which 
these doctrines maintained. In the German 
Reformation the people of the Netherlands expe- 
rienced all the hardships and persecutions that 
Catholic Spain could impose upon them. Under 
Charles the Fifth and Philip the Second the Span- 
ish Inquisition was introduced, and the heretics 
were punished with merciless cruelty. No mercy 
was shown to those who claimed the right of free- 
dom of conscience or of religious toleration. Mar- 
garet of Parma, daughter of Charles the Fifth, 
as Regent of the Netherlands, made every effort 
to down the heretic and to suppress the Protest- 
ant movement rapidly growing under the perse- 
cutions of the Inquisition. After her removal the 
Duke of Alva sticceeded to the Regency. The 
cruelty of this monster and bigot has made his 
name the most detested among all men and all 
times. He ruled with such vengeance that even 
his Catholic subjects, opposed to the Inquisition, 
but loyal to their church, were executed on the 
slightest evidence. Among the Catholic noblemen 
in the Netherlands who countenanced modera- 
tion and resisted the Inquisition three great char- 
acters stand out in history — William, Prince of 
Orange, Count Egmont and Count Horn.. The 
two latter were executed by Alva on the ground 
that they had opposed the Inquisition and had 
given encouragement to heresy. Count Egmont 
was the hero of St. Quentin and Gravelines, and 
as commander of the Spanish armies had won the 
two greatest victories ever won by Spain over the 
French. He was one of the most popular men of 
his day ; his services to the country had been emi- 
nent. He stood with his people for freedom of 
conscience. This was too much for Philip and 
Alva. He and Horn were judicially murdered 
by decapitation in the park fronting the palace in 



Brussels. The people of Brussels have erected 
bronze monuments to these two patriots, which 
stand in the park near the place of the execution. 

William. Prince of Orange, generally known 
as \Villiam the Silent, was a young nobleman of 
great talent and purity of character. He enjoyed 
the love and esteem of Charles the Fifth, which 
gave him great influence in the government of the 
Netherlands under Margaret. He opposed the 
Inquisition, and did all that was possible to arrest 
its work. He saw what was coming, and retired 
to (jermany when Alva was made regent. In 
this way he escaped the fate of Egmont and Horn. 
William of Orange now became the great leader 
of the revolt against Spain. Under his master 
hand the Dutch Republic was molded into shape, 
and the Netherland people were liberated from 
Spanish rule. The history of the Dutch Republic 
is a history of war and bloodshed, of fierce strug- 
gle and contest for a single principle — the right 
of man to worship his Maker after the dictates 
of his own conscience. This principle, so bitterly 
contested, was established by the courage and 
patriotism of the Dutch people, to whom the 
world owes a debt which cannot be too highly 
appreciated. The wonderful wealth and pros- 
perity of the people of Belgium and Flolland can 
be attributed to their industry, thrift and love of 
freedom. These two small kingdoms, surroiuided 
by the great powers of Europe, have built up many 
large and beautiful cities ; have established pros- 
perous colonies in distant cotmtries, and carry 
on a commerce that it a marvel even to larger 
nations. No section of the world is so densely 
populated as these two kingdoms, and perhaps no 
people enjoy greater freedom and prosperity. 

After spending two nights and one day in Brus- 
sels we left Saturday morning for Hague. 
( To be continued.) 



In our biography of Dr. Walter Henry O'Neal, 
class of 1871, of Gettysburg, Pa., published in 
the September, 191 1, Bulletin, we neglected to 
state that Dr. O'Neal' was the secretary member 
of the L'nited States Pension Examining Board 
for Adams county during the administration of 
the late President Cleveland. At present he is a 
member of the National Geographic Society and 
director of the Gettysburg National Bank. 



Dr. Claude C. Smink, class of 1909, is located 
at Lauraville, Md. 



THE HOSPITAL BULLETIN 



167 



SEE AMERICA FIRST, 



r>V l^ANPOLPH WiNSI.OVV. 



3- 



TIIK YOSEMITE \' AI.I.E^". 



'J'lic itinerary of our special train demanded 
that we leave Los Angeles on Friday, June 30, 
at 4 P. M., and consequently we had to forego 
certain festivities at Pasadena and elsewhere that 
wc would have been pleased to have participated 
in ; in fact, we would have been pleased to have 
lingered longer in Los Angeles, and to have ex- 
plored the many attractions of that city and its 
environs. At the appointed time, therefore, our 
company met at the Southern Pacific station and 
entrained for the Yosemite N'alley, which is one 
of the National parks of the country, controlled 
by the Government and guarded by L'nited States 
cavalrymen. We had hardly gotten well settled 
on the train when we were informed that an ex- 
])losion of dynamite had occurred, wrecking a 
freight train and blocking the direct route, and 
that it would be necessary to make a 90-mile de- 
tour in order to proceed on our journey. This 
brought us to Oxnard, where there is an enormous 
beet sugar factory, and through a region where 
beets are the chief object of cultivation, and 
thence through lemon groves back to the main 
line. It is quite a step from Los Angeles to the 
Yosemite, and we were more than 24 hours in 
reaching our destination. 

At ]\Ierced we transferred to the Yosemite Val- 
ley Railroad and ran up the wild Merced Valley, 
with its rushing river and beautiful scenery, to 
El Portal, at the entrance to the park. Here we 
took busses and were driven 14 or 15 miles over 
a narrow and dusty road to the Sentinel Hotel, 
or, if one prefers, to one of the tent villages that 
are established in the valley. The Yosemite Val- 
ley is a deep cleft in the heart of the Sierras, about 
seven miles in length and three-quarters of a mile 
wide : its floor is level and covered with beautiful 
trees, and through its center the ice-cold Merced 
River rushes on its rollicking way. The valley is 
bounded by sheer walls of riven rock, cleft by 
some mighty cataclysm and rearing their barren 
sides from three-quarters of a mile to a mile in 
the air. These grim and apparently unconquer- 
able barriers are carved into many fantastic 
shapes, forming arches, domes, half domes, pin- 
nacles and spires, while from the rim of the moun- 



tain wall tumble with a roar and rumble numerou.-^ 
waterfalls to the bottom of the valley hundreds, 
and in some instances, thousands, of feet below. 
There is perhaps no other place of equal size on 
the face of the earth where there are so many 
stupendous cataracts ; indeed, it it stated that no- 
where else can waterfalls of ec|ual height be 
found. The Yosemite Falls are 2630 feet high, 
but the descent is not absolutely unbroken, though 
its impact is sufficient to shake the earth and to 
cause a rain of spray to sprinkle the surrounding 
area for a considerable distance, and to produce 
luxuriant and verdant vegetation. The Bridal 




NEVADA FALLS, YOSE.MITE VALLEY. CALIFORNIA. 
ON THE ROAD OF A THOUSAND WONDERS. 



Veil, Vernal, Nevada and Illilovette are other 
magnificent and beautiful cascades, while there 
are also many smaller falls of equal or even 
greater altitude. The Ribbon Falls have an alti- 
tude of 3300 feet, but, owing to their narrowness, 
are ribbonlike in appearance ; the Widow's Tears 
is a tenuous fall that becomes very slight or dries 
up entirely in the summer, and the Widower's 
Tears is an even less durable stream, that dries 
up still more quickly. 

As one goes into the park several natural rocky 



i68 



THE HOSPITAL BULLETIN 



formations attract attention : one is a huge rocic 
which at a little distance looks like an enormous 
elephant, while in another place the perfect figure 
of a cat is jiresented on the face of a precipitous 
cliff. El Capitan is a bare rock rising vertically 
3300 feet in an unbroken mass and dominating 
the landscape for a long distance. Cathedral 
Rock is so-sailed from its resemblance to the 
Duoma at Florence, while nearby are the Cathed- 
ral Spires which rear their gothic peaks high into 
the sky. Many other remarkable rock formations 
claim the attention of the visitor, but cannot be 




EL C.^riTAX, YOSK.MITi: NAI.I.KV. ( AI,IFnltNI.\. 

mentioned more in detail in this short narrative. 
The valley itself is a natural park, level, verdant 
and umbrageous, with trees of many varities, a 
varied flora, noisy streams of water and a placid 
lake that reflects objects as in a mirror when the 
sun siiows his face over the mountain's rim. This 
]K)ol is called Mirror Lake, and amorous swains 
and their sweethearts delight to have their double 
|iresentment depicted from a rock a little distance 
from the shore. 

Near the center of the valley is the .Sentinel 
Hotel, which is a rather rough, but entirelv com- 



fortable, hostelry, with excellent food and serv- 
ice. A number of cottages are also close at hand 
to house the overflow. The cottage at which the 
writer lodged was built around a huge tree, which 
projected through the roof. Camps are also es- 
tablished at several points, where those w'ho pre- 
fer to live the simple life can have their desire 
fulfilled. Life in the valley is rather unconven- 
tional, and one usually goes clad in his or her 
oldest and roughest clothes. The diversions are 
either walking or riding in the valley, or usually 
up the trail to (ilacier Point, or to other points of 
vantage. From the hotel daily trips are made by 
stage to the Mariposa Cirove of Big Trees, which 
are the oklest and largest living things in the 
world. It is believed that these trees are over 
5000 years old. I did not have the opportunity to 
visit this particular grove, but did visit another 
111 nearly eqtial size and antiquity. Instead of 
making the trip to the Mariposa Trees, the writer 
iiiotinted the quarter deck of a rough horse and 
embarked on a bone and joint racking voyage of 
15 miles up and down the trail to Glacier Point. 
.\s he had not employed this method of locomo- 
tion for 25 or 30 years, his most delightful mo- 
ment was when he dismounted at the termination 
of the trip, (ilacier Point is a bold projection 
overlooking the valley from an altitude of 325a 
feet. It is rather difficult to reach for the tender- 
foot, but amply repays the voyager for the dis- 
comforts of the ascent. L'nder the direction of 
coin]jetent guides tourists are escorted in long 
trains up the narrow and precipitous trails. At 
many points there are beautiful vistas of the- 
mountains and valleys, and at other points we 
have near views of the magnificent falls. A por- 
tion of the trail is through thickly wooded 
stretches, where huge trees raise their lofty heads 
far into the azurean dome of the heavens, while 
frequently trees of considerable size grow from 
clefts in the rocks, where to the inexperienced 
eye there seems to be no soil whatever. In some 
places the trail is apparently cut out of the face 
of the cliff, and a misstep of your horse means a 
dash downwards of hundreds of feet. .\t such 
l)laces your animal fre(|uently takes especial de- 
light in getting as near the edge as possible. 
while you would much prefer to remain as far 
off as )(Hi can get. or, with his feet braced on the 
rim of the trail, he reaches his head and neck 
into space to crop a twig that may project toward 
him. However, the animals are sure-footed and 



THE HOSPITAL BULLETIN 



\6<) 



trusty, ami if you give them free rein they will 
liear you in safety to your destination. At the 
.summit is a small hotel where you can sjet lunch, 
anil if \'ou prefer, remain overniijht. The view 
from here is wonderful; for nearly loo miles you 
see the snow-clad tops of the high Sierras, with 
leaks and intervening;- canyons forming a wild 
and jagged scene. hViim here also the valley aj)- 
I'cars to he a verdant gartlen, with roads like tapes 
running in various directions, and people and 
teams looking like ants and hugs as they walk 
or ride along the paths. The descent is hy the 
short trail, which is much more preci]3itons than 
the one hy which we ascended, and much shorter. 

There is a regular moving picture outfit in the 
'N'osemite, and here many of the scenes of robbery 
and assault that one wonders at in the theaters 
are carefully worked out. The Sentinel Hotel 
is ke])t oi^en the \ear round, though the ground 
is covered with snow. It is said to have sufficient 
patronage from Californians, who come in order 
to enjoy the snow scene with which they are un- 
familiar, to justify the elTort. The National 
reservation is much more extensive than the val- 
ley, and covers an area of 36 by 48 miles. I sup- 
l)ose it is chiefly a wild animal range or a forest 
])reserve, as it does not seem to be thrown open 
to the public. W'e left the valley in busses at _' 
r. Af. on July 3, and retraced our ste]« to El 
Portal, where we found our special train waiting, 
and resinned our journey in the evening. On the 
nKirning of July 4 we were running through a 
broad valley where grass and grain fields ex- 
tended almost as far as the eye could reach, and 
where the farmers were busy gathering their 
liarvest. 

Nothing is more characteristic of California 
than its contrasts. In some sections one sees onl_\' 
orange groves ; in another, lemon trees, olives, 
vineyards or vast tracts in which beets are the 
chief or only products. A considerable portion 
of the State is arid, and requires artificial irriga- 
tion to render the soil productive, while in other 
])arts there is an abundance of water derived from 
the melting snowcap of the high mountains. .\ 
large area is treeless, except where planted and 
irrigated ; other areas produce the largest, tallest 
and oldest trees in the whole world. The fruits 
are usually much larger than those of the same 
variety in other sections of the country, and in 
some instances are gigantic. Minerals are abun- 
<lant, though there are other areas in which the 



]irecious metals are produced in greater quantities. 
There is a vast production of petroleum, and the 
oil wells are found even in the Pacific Ocean. 
The railroads use coal oil, as do the steamboats 
also, instead of coal, and it is certainly much 
more pleasant for the passenger, as there are no 
sparks and cinders to get into his eyes or to burn 
holes in his garments. ' )f course, there is smoke, 
but not tangible ]iarticles of dirt to distress one. 
.At g .A. M. (in July 4 we reached the pier at 
()akland, and shortly thereafter were crossing 
the beautiful San Francisco Bav to the historic 




VEliX.VL F.VLI.-i, VOSK.MrriO \AI,I,KV. r.VI.I Foli.NI.V. 

cit}' of the same name, which, like a ])hoeni.\, is 
rising from its ashes into a new and more sub- 
stantial, if less picturesque, city than the one that 
was destroyed five years ago. San Francisco Bay 
is a wonderful body of water, communicating 
with the Pacific Ocean b\' the narrow Golden 
Gate, large enough to float the navies of the world, 
and absolutely landlocked and safe. The cities 
of San Francisco, Oakland. I Berkeley and Ala- 
meda, besides smaller towns, are clustered on the 
shores of the bay. and are populous and busy cen- 
ters of trade and commerce. 



I/O 



THE HOSPITAL BULLETIN 



LWERSION OF THE UTERUS, WITH A 
REPORT OF AN ACUTE CASE OF 
COMPLETE INVERSION AND ITS 
TREATMENT. 



By E. H. Kloman, M.D., 
Associate in Obstetrics, University of Marylaiitl. 



I have hesitated reporting these cases for sev- 
eral months, as I feel that apologies are dne for 
my attempting to write upon such a rare subject. 
Yet it is such a serious condition that I feel it my 
tluty to report the cases, and in so doing give a 
iew words upon the subject. 

There are several varieties and grades of in- 
version, and likewise several etiological factors. 
As the only two cases which I have been called 
upon to treat have occurred in obstetrical prac- 
tice, I will not attempt to discuss those cases be- 
longing more clearly to gynecology. 

The puerperal inversion is far more common 
than non-puerperal, and is generally said to be 
about 85 per cent, for the former and 15 per cent, 
for the latter. So rare is this condition that many 
prominent obstetricians never see a case. JVil- 
liaiiis' Obstetrics gives one case in 100,833 de- 
liveries in London, while not a single case was 
found in 250.000 labors in the St. Petersburg 
Hospital. I am inclined to think it is more fre- 
quent than either of these instances would indi- 
cate, as it is a condition caused in large part by 
a careless accoucher or midwife, and naturally es- 
capes the literature. 

Puerperal inversion may either result from a 
full-term delivery or from an abortion. It may 
Ijc complete or incomplete, all gradations occur- 
ring from a slight invagination of the fundus 
(most frec|ueiitly near one of the horns) to a 
complete inversion of the uterus and vagina. 

The predisposing etiological factors in inver- 
sion of the uterus are as follows : 

The conditiim is most fre<|uent in primipara, 
with disteiuion (jr relaxation of the birth canal, 
a large jielvis, the erect posture during labor, a 
short cord, laceration of the cervix and attach- 
ment of the placenta or a tumor to the fundus. 
One or more of these causes, combined with a 
determining cause, are generally found to accoinit 
for the condition. 

Before giving tlie determining causes, I wish 
to .say that the case wliich I rei)ort was one due to 
direct carelessness, and 1 make no excuse for its 



occurrence in our clinic, as it was a lesson to all 
who observed it. T'ortunately, it terminated 
favorably. 

Among the determining causes are, first, too 
vigorous use of Crede's method, or pressure on 
the fundus when the uterus is not contracted ; 
traction on the cord; tumor of the fundus (this 
causes a great majority of non-puerperal inver- 
sions) ; blows on the abdomen or contraction of 
the abdominal muscles with an atonic uterus. 

The weight of the abdominal viscera alone may 
cause it when the patient is in erect posture with 
a relaxed ontlet and atonic uterus. 

The symptoms are most frequently acute and 
alarming, marked by a nervous condition of the 
patient, faintness, ppst-partum hemorrhage, shock 
and marked pelvic discomfort in all grades of in- 
version. On the other hand, symptoms are some- 
times slight, and the condition goes unnoticed. 

If the inversion is complete, the diagnosis is 
simple, but if only a beginning inversion, as in 
my case when the fundal depression was slight, 
it is more difificult. Indeed, the complete inver- 
sion seems to be difificult at tiiues, as I gather 
several cases from the literature when mistakes 
are made confusing the protruding fundus with 
the head or breech of the child, a mole, a clot, a 
polypus or placenta. I think these mistakes are 
made in consequence of the critical condition 
of the patient and the unsuspecting and alarmed 
practitioner. 

As a result of this error in diagnosis, the uterus 
is torn away for a tumor, clot, placenta, or what 
not, and simultaneously the patient's life and the 
physician's reputation are lost. 

Treatment. — The prophylactic treatment is the 
most important, as the condition is more fre- 
f|uently due to mismanageiuent than to unavoid- 
able causes. And if the reader is ever so unfor- 
tunate as to have a case of complete inversion to 
handle, he will at once think of the familiar and 
true saying, "An ounce nf prevention is worth a 
]>ound of cure." 

Here are a few "don'ts" which may save you 
this embarrassment : 

Don't try to express a jjlacenta until it has be- 
come detached from the uterus. 

Don't make pressure on the fundus when the 
uterus is soft, especially when the cervix is torn 
and the outlet relaxed. 

Don't try to aid the expression of placenta by 
tracliiin on cord. 



THE HOSPITAL BULLETIN 



171 



If partial inversion occurs, it can usually lie 
(letectcd by palpation on the ahdonien, when a 
dejiression will he felt in the uterus, sjencrally 
accompanied with iirofusc hemorrhage. It is 
best to ]iut the patient under an anesthetic at once. 
Prepare the patient and your hands aseptically ; 
wear rubber gloves and introduce hand into uterus 
and replace the inversion. If the inversion is 
marked, I wotdd advise a sterilized gauze pack. 
If only slight, and the uterus contracts freely. I 
think a hot normal salt douche would sufilice. 
provided there is no marked post-partuni hemor- 
rhage after replacing inversion. 

When the inversion is complete and seen at the 
time of labor, the placenta may be still attached. 
Most authorities advise leaving the placenta in- 
tact. In my case I detached it, as I was sure I 
would experience great diffictilty in replacing the 
organ should I leave the large placenta attached 
over the very portion which I replaced first. 

The hemorrhage was not increased by the de- 
tachment. I wiped the uterus with hot sterile 
salt and gauze after the removal of the placenta, 
and with the palm surfaces of both hands on pos- 
terior wall : I used the ends of thumijs to in- 
vaginate the fundus, gradually increasing the re- 
invagination until I could put mv whole hand in 
the uterus. 

This is very different if yoti see the case for the 
first time several hours after the accident, as the 
OS will begin to contract and the replacement may 
become impossible. Then it is best to pack the 
vagina, after pushing the uterus back in the vault. 
and arrange for operative procedure in hospital 
if possible. 

It is seldom necessary to do a hvsterectomy 
unless such complications set in as gangrene from 
constriction of the os. 

C.VSE XO. I. CO.MPLETE I.WER.SION OF UTERI'S .\.\1) 
V.\(;iN.\ FOLLOWIXC FORCEP.S DELIVERY. 

History. — Name, B. A.; white; single; age 18. 
Primipara — Pelvic measurements above average 
for girl 18 years; superior spines 2/; crests 29; 
trochanters 31 ; Raudelocqne's diameter 20.5. 
Patient went into labor at full term with occiput 
presenting, .\fter 24 hours of labor the mem- 
branes ruptured, but the head made no progress 
in its descent with three hours of hard pain after 
the ru])ture of tlie membrane. A mid-forceps 
operation was done under chloroform anes- 
thesia, resulting in the delivery of a very large 



living child with a cervical laceration extending 
almost to the left fornix of vagina. An assistant 
who was keeping watch over the uterus was re- 
c|uested to express the placenta when detached. 
This he failed to understand, and made pressure 
on the fundus of a relaxed uterus with a lacerated 
nutlet. This resulted in a complete inversion of 
uterus and vagina, the placenta still attached to 
the uterus. .\ sudden .gush of blood preceded 
the expulsion of uterus, but very little shock was 
noticed on part of patient, possibly due in part to 
her profound anesthesia. No great hemorrhage 
was evident, but the pulse rate ran as high as 
140. I removed the placenta at once, and after 
wiping the endometrvmi with hot sterile gauze I 
grasped the posterior part of the body with the 
palm surfaces of hands and replaced the fun- 
dus, first by pushing up with the thumbs and 
finally introducing the whole hand into the cavity 
to see that replacement was complete and to aid 
contraction. This was followed by a hot dotiche 
and gauze pack. The cervical laceration was re- 
paired later. Involution was complete, and 
uterus returned to its normal position. This pa- 
tient suffered from vague pains for several 
months, but when seen six months after opera- 
tion was in excellent condition, with no pain. 

(■.\SE NO. II. .SEEN IN CONSl.TLTATION WITH DR. 
. FORCEPS DELIVERY OF A 12- 
POUND CHILD. 

Indications. — Uterine inertia due to large child 
and hydramnios. Shortly after delivery the pla- 
centa was found free in vagina ; hemorrhage was 
profuse, and when attempting to massage the 
fundus a distinct depression was noticed in the 
left horn of uterus. Hemorrhage became alarm- 
ing, and as uterus did not make any attempt to 
contract or retreat, I introduced one hand into the 
cavity and found a partial inversion. This was 
replaced at once and followed by a hot douche 
and massage, with a firmly retracted and con- 
tracting uterus resulting. It is very easv to make 
a mistake and call a partial inversion a tumor or 
polyp. In one case of partially inverted uterus, 
erroneously supposed a poly]), the protrusion was 
pulled down through the e.xternal os and removed 
by am])utation, resulting fatalh'. 

i6ig St. Paul Street. 



Dr. Hugh Warren Brent, class of 1903, is lo- 
cated at 906 X. Calvert street, Baltimore, Aid. 



172 



THE HOSPITAL BULLETIN 



IT STL' LA IN' ANO. 



n.v M. E. Mai.lex. 
Senior Medical Student. 



l-'istula in ano is tlie unhealed track of an ab- 
scess, w hicli is lul)ercular in 1)5 ])er cent, of cases. 
'1 here are three (hfferent kinds of fistula in ano — 
( I ) the blind external, (2) the blind internal, and 
lastl}' the complete. In the first variety an open- 
ing exist from the skin around the anus to the 
perirectal soft parts, thus not communicating with 
th.e rectum. In the blind internal an artificial 
o])ening projects from the rectum into the sur- 
rounding tissues, but not reaching the skin. In the 
last variety there is a complete opening from the 
rectum through the skin. In tubercular fistula the 
external opening is rather large and very irregu- 
lar, with thin edges, shows no granulation through 
which i.s discharged small amounts of blood-tinged 
pus, and congestion of the immediate skin is to be 
observed. 

Etiology. — As 95 per cent, of fistula in ano is 
due to tuberculosis — and in most cases it is a sec- 
ondary process — we should always ascertain as 
to the presence of tuberculosis in the adjacent 
structures. It is usually the drainage tract of 
ischio-rectal abscesses, tubercular ulcers of the 
rectum, anal abscess, etc. 

Symptoms. — The symptoms of a complete fis- 
tula are the passage of feces or gas through the 
opening. .After a tin^e incontinence of feces is 
apt to occur as a result of thickening of the mu- 
cosa of the rectum from repeated attacks of in- 
flammation, which partl\- or wlmllv destroys its 
sensibility. From time to tiiue the opening will 
be blocked and new abscesses be formed. In 
probing a fistula use a thin, easily-bent instrument. 

Treatment. — First in importance is cleanliness. 
The rectum should be irrigated with hot normal 
salt solution. Xever use antiseptics in the rectum. 
I'lace the patient in the litliotnni)- iiosition. Pass 
a groove director into the external opening to the 
bowel and Ijring the other end externally. Cut 
upon this. Cut the sphincter at a right angle to 
its fibres, and only once. It is liest in tubercular 
cases to separate the tissues with a cautery. 
Search with a small jirobe for branching sinuses, 
and if found slit them open. Curet all the sinuses 
found. Remove superfluous tissues, irrigate with 
normal salt solution, ])ack tightly with iodoform 
and apph a T bandage. Dress every day. If 



sluggish, touch up with silver nitrate. Dowels 
should be constipated after the operation. 

.-Inestlietic. — .Vnesthetize the patient with ether, 
unless the fistula is tuberculous, in which case use 
local anesthesia — quinine muriate and urea. 
Ether is to be avoided if phthisis exists, as its in- 
halation is often followed by a dissemination of 
the process. It may even relight a quiescent tu- 
bercular lesion. 



Amongst our Florida alumni are : 

James E. Rawlings, '04, 10 P.each street, Day- 
tona. 

George W. Betton, '95. 539 Riverside avenue, 
Jacksonville. 

Xorman M. Heggie. "02, Buchanan Building, 
Jacksonville. 

Charles L. Jennings. "o5, 303 Cedar street. 
Jacksonville. 

James D. Love, '97, 501 Laura street, Jackson- 
ville. 

Robert H. McGinnis. "97. 501 Laura street. 
Jacksonville. 

Robert L. May, "90. 38 \\'. Beaver street. Jack- 
sonville. 

L. Denham Parker. '72, 30.') W. Forsyth street, 
Jacksonville. 

Joseph L. Romero. "79, 2109 Kershell street, 
Jacksonville. 

Charles Edward Terry. '03, 118 \\'. .\dams 
street, Jacksonville. 

George Walter. '10, 131 W. Adams street, 
Jacksonville. 

Frederick J. W'ass, '05. 136 E. Duvall street, 
Jacksonville. 

.Abner J. I'. Julian. '83, Lake City. 

Hugh W. Henry. 91, Lake W'ier. 

George W. Brown, '89, Lawtey. 

Lester Julian Efride, '03, Live Oak. 

.Arthur L. Izlar, '89, 71 W'enona street, Ocala. 

Calvin T. Young. "03. Plant City. 

John Cox Keaton, '07, Quincy. 

Samuel Pulcston. 02. Sanford. 

Benjamin J. liond, "04, Tallahassee. 

Fred C'liftnii Moore, '03, Tallahassee. 

Ilem-y Edwards Palmer, '92, Lafayette and 
.\dams streets. Tallahassee. 

Charles W. liartlett. '93. 1414 Seventh avenue, 
Tam]ia. 

Rollin Jefferson, '03, 508 Twiggs street, I'anijia. 

J. P.rown Wallace, '97, /oGyi Franklin street. 
Tanqui. 



THE HOSPITAL BULLETIN 



173 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore. Md. 



and his only desire is to see his school firmly 
fixed upon a sure foundation, lirethren, help us 
with your money, your work and your construct- 
ive advice. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 

Nathan Winslow, M.D., Editor 

Baltimore, November 15, 191 1. 



••GIVE. NOT GRUDGINGLY, OR OF NE- 
CESSITY: FOR GOD LOVETH A 
CHEERFUL GI\"ER." 

■"The peo])le rejoiced for that they oft'ered wil- 
lingh- : '■'■'■ '■'- '' and David the King also re- 
joiced with great joy." 

King David had in his heart to build a temple 
at Jerusalem, and he began to make preparation 
for this great undertaking. First, he gave freely 
of his own treasure, and then he called upon the 
l^eople to aid in the work, and the monumental 
rec(jrd remains to this da\-, that they gave wil- 
lingly with rejoicing. We do not wish to be con- 
sidered flippant, or to apply lightly to a secular 
enterprise the words of sacred writ, yet it seems 
as if the truths contained in the record quoted 
are ai)])licable to the undertaking in which we 
are engaged. In a sense we are building, or at- 
tempting to perpetuate, a temple of medical science 
at which we have received instruction, inspiration 
and manifold advantages. After more than a 
century of honorable and useful endeavor, the 
medical school of the L'niversity of Maryland 
finds itself confronted with new conditions and 
new problems. The times have changed, and we 
must change with them. For some months we 
have been ap])ealing to our alumni and others 
for assistance. The object of this eli'ort. which is 
entirely altruistic on our part, should appeal to 
the loyalty, gratitude and generosity of those who 
have received marked benefits from the institu- 
tion. It ought not to be necessary to beg such 
individuals for contributions to the endowment 
fluid, but they shoukl give willingly according to 
their several ability. Recognizing the imperative 
necessity of placing our school on a solid basis, 
the writer has undertaken a task that is exception- 
ally distasteful to him. He has no expectation 
whatever of any personal gain from his efforts, 



LET I'S LIST YOU AS A SUBSCRIBER TO 
THE PATHOLOGICAL ENDOW- 
MENT FUND. 

The subscriptions to Niivcmber 1 are as 
follows : 

Robinson bequest $5000 

Dr. Hugh Hampton Young, J. H. U 100 

Prof. R. Dorsey Coale, Ph.D 100 

Dr. S. J. Meltzer, LL.D., New York. ..... 10 

Dr. Gideon Timberlake 25 

Mr. H. P. Ohm 10 

Dr. Samuel W. Moore, D.D.S 25 

Dr. A. Sagebien, D.D.S. , Cuba 5 

Thomas C. Basshor Company 10 

Hospital ESuIletin 5 

Maryland Medical Journal 5 

Miss C. M. Selfe 5 

Mr. Geo. Lewis. Florida 50 

Air. J. Henry Smith 25 

.Mr. R. A. Krieger 5 

Hospital Bulletin Co 5 

Summers Printing Co 15 

Williams & Wilkins Co 50 

Dr. John J. R. Krozer, 1848 50 

Dr. Eugene F. Cordell, 1868 10 

Dr. John G. Jay, 1871 25 

Dr. C. R. Winterson, 1871 10 

Dr. Joseph T. Smith, 1872 10 

Dr. \V. J. Young, 1872 25 

Dr. Isaac S. Stone, 1872 10 

Dr. Thomas A. Ashby, 1873 100 

Dr. David W. Bulluck, 1873 100 

Dr. Robert Gerstell, 1873 5 

Dr. Randolph Winslow, 1873 100 

Dr. H. T. Harrison, 1874 5 

Dr. John D. Fiske, 1875 5 

Dr. Wilmer lirinton, 1876 I05 

Dr. Wni. E. Wiegand. 1876 10 

Dr. Thos. Chew Worthington. 1870 5 

Dr. R. H. P. Ellis, 1877 10 

Dr. Charles W. Mitchell, 1881 100 

Dr. L. Ernest Neale, 1881 100 

Dr. E. L. Meierhof, 1881 50 

Dr. J. M. Hundley, 1882 250 

Dr. Henry Chandlee. 1882 10 

Dr. Henry Chandlee. 1882 15 

Dr. B. Merrill Hopkinson, 1885 25 



174 



THE HOSPITAL BULLETIN 



Dr. J. C. Perry, 1885 100 

Dr. H. C. Reamer, 1885 10 

Dr. Frank Martin, 1886 100 

Dr. John R. Winslow, 1888 50 

Dr. C. W. McElfresh, 1889 100 

Dr. Saint Clair Spruill, 1890 100 

Dr. Rupert Blue, 1892 100 

Dr. Frank J. Kirby, 1892 50 

Dr. Walter B. Kirk, 1893 5 

Dr. Martin J. Cromwell, 1894 50 

Dr. Charles T. Harper, 1894 50 

Dr. Harry Adler, 1895 too 

Dr. Jose L. Hirsh, 1895 50 

Dr. Joseph W. Holland, 1896 50 

Dr. R. W. Sturgis, 1896 2 

Dr. Guy Steele, 1897 15 

Dr. Page Edmunds, 1898 50 

Dr. Albert J. Bossyns, 1898 5 

Dr. L. W. Armstrong, 1900 10 

Dr. S. Demarco, 1900 50 

Dr. M. S. Pearre, 1900 5 

Dr. Irving J. Spear, 1900 50 

Dr. \\'m. Tarun, lyoo 50 

Dr. J. D. Reeder, 1901 50 

Dr. Nathan Winslow, 1901 50 

Dr. Wm. R. Rogers, 1901 23 

Dr. Arthur M. Shipley, 1902 250 

Dr. H. C. Davis, 1902 10 

Dr. H. L. Rudolf, 1902 25 

Dr. Hugh Brent, 1903 25 

Dr. G. C. Lockard, 1903 25 

Dr. Geo. S. M. Kieffer, 1903 25 

Dr. H. J. Maldeis, 1903 25 

Dr. Howard J. Iglehart, 1903 25 

Dr. R. C. Metzel, 1904 10 

Dr. Ejnar Hansen. 1904 10 

Dr. Robert P. Bay, 1905 100 

Dr. B. F. Tefft, 1905 100 

Dr. Jos. A. Devlin, 1906 10 

Dr. W. F. Sowers, 1906 25 

Dr. Robt. W. Crawford, 1906 25 

Dr. Leo Karlinsky, 1906 20 

Dr. J. F. Hawkins, 1906 25 

Dr. Frank S. Lynn, 1907 25 

Dr. T. H. Legg, 1907 5 

Dr. .\lbert H. Carroll, 1907 23 

Dr. Edgar S. Perkins, 1907 23 

Dr. J. N. Osljurn, 1909 3 

Dr. E. H. Klomau, 1910 25 

Total $8702 

Additions f(ir the innnth $300. 



THE MARYLAND STATE BOARD 
REPORT FOR JL'XE, 191 1. 



There has been considerable uncertainty as to 
the result of the examination of the Maryland 
State Medical Examining Board in June. 191 1. 
The manner in which the results are tabulated is 
a very unfortunate one, and it is impossible for a 
person who has not made a long study of these 
reports to interpret them correctly ; indeed, it is 
often impossible for an expert to determine ac- 
curately the results. The report for June, 1911. 
as published in the Maryland Medical Journal 
and in the Bulletin of the Medical and Chinirgical 
Faculty of Maryland was no exception in this re- 
spect. After considerable correspondence with 
Dr. J. McPherson Scott, secretary of the Board, 
we think we have now arrived at a correct under- 
standing of the results, as far as our own grad- 
uates are concerned. The Maryland Medical 
Journal report is erroneous, in that we are cred- 
ited with fewer successful candidates than we 
were entitled to, as Drs. Jas. E. Quigley and S. 
H. Rynkiewicz are credited to Jefferson iXIedical 
College, and not to the University of Maryland : 
and, on the other hand, we had four failures in- 
stead of three. The results, therefore, are 34 ap- 
plicants passed and 4 failed. Of the class of 191 1, 
2j passed and 2 failed. 

The following is the correct list of those who 
passed successful examinations and received 
licenses to practice medicine in Maryland, with the 
year of graduation : 

Francis H. Digges, 1904. 

Geo. E. Bennett, 1909. 

Chas. A. Neafie, 1909. 

John G. Schweinsburg, 1909. 

R. Gerard Willse, 1909. 

W. \'an \'. Parramorc. 1910. 

.Xatiianiel Garb, lyio. 

Jacob 15. .Asper, 191 1. 

Walter O. Bacon, 191 1. 

Buchler S. Boyes, 191 1. 

William L. Byerly, 1911. 

Henry 1). Causey, 191 1. 

Herbert .\. Codin.gton, 1911. 

Louis H. Dou.glass, 1911. 

Chas. L. Dries, 191 1. 

Jas. J. I''delcn. 191 1. 

.\. L. 1 [ornstein, i(;i 1 . 

Kennetii 1!. Jc^nes, |i;i 1 

Ciias. I I. Keesnr, ii;i 1 . 



THE HOSPITAL BULLETIN 



175 



Chas. R. Law, Jr., 191 1. 
Isaac .M. -Macks, igii. 
("leo. Y. Massenberg, 1911. 
Walter S. Niblctt, igii. 
Elijah I'2. Xicholls, 191 1. 
X'ernon L. Oler, 191 1. 
John Astro, 191 1. 
Jas. E. Ouigley, 19TI. 
S. H. Kynkiewicz, 1911. 
Chas. L. Schmidt, 1911. 
Joseph Stomel, Hji i. 
Ralph L. Taylor, 191 1. 
Grafton D. Townsend, 191 1. 
Albert (I. Webster, i(;ii. 
Richard L. Williams, 191 1. 



ABSTRACT 

The Xcw }'(';■/>' Medical Journal. C)ctober 7, 
1911, publishes an article by Dr. Harr}- Adler, 
class of 1895, ^"fl Dr. Howard Elmer Ashbury, 
class of 1903. entitled "Further Experience in 
X-ray Diagnosis of Ulcer of the Stomach and 
Duodenum, Embracing Seventy-five Cases," in 
which the following appears : 

"Our first work on this subject was presented 
before the Medical and Chirurgical Faculty of 
Maryland in April, 1910. with a report of si.K 
cases of ulcer diagnosticated by the X-ray. A 
second paper was presented before the American 
Rontgen Rav Society in September, igio, entitled 
'X-ray l-'indings in (lastric and Duodenal Ulcer.' 
At that time 45 cases had been examined. Since 
then we have made X-ray examinations of 30 ad- 
(litifinal cases, making a total to date ( March 20, 
1910 of 75 cases. ( )ur intention in presenting 
this paper is to bring before the society the Ront- 
gen method as a distinct advance in the diagnosis 
of ulcers, and as a probable means of determining 
results of treatment when used in connection 
with clinical symptoms. 

"In our etiforts to locate gastric and duodenal 
ulcers we have chosen a systematic and constant 
technitjue, and by careful interpretation of plates 
have been able to eliminate most sources of error. 
Any addition to the present means of diagnosticat- 
ing ulcers will be of great assistance and the 
treatment will be much more satisfactory if we 
are able to approximate the size and location of 
the ulcer. The principle of the method is based 
upon the idea that the crater of an ulcer will re- 
tain a salt of bismuth after the normal mucosa 



has been cleared of it by the peristaltic action of 
the stomach and intestine. Dr. llemmeter. before 
this association, at the meeting in Uoston, spoke 
of the possibility of X-ray demonstration of gas- 
tric ulcer : and while no plates were shown in 
evidence, it is due to the inspiration of his sugges- 
tion that this work was undertaken by us. 

"That a gastric ulcer will retain bismuth is evi- 
denced b}- the following case reported by Xaunyn : 
A ]iatient who had had a profuse gastric hemor- 
rhage was given 20 grammes of bismuth sulmi- 
trate 36 hours before death, and 24 hours later 
an additional 5 grammes were given. Autopsy 
showed that the ulcer was filled with a clump of 
bismuth, about 20 grammes m weight, while the 
remainder of the stomach contained a very small 
quantity. With the idea of investigating the be- 
havior of bismuth with artificial ulcer, the follow- 
ing experiment was carried out by Dr. Robert P. 
P>ay of the University Hospital (Baltimore) : 

" "A dog was put to sleep, the abdomen opened, 
and an incision made into the stomach. Through 
this incision a portion of gastric mucosa was de- 
livered from the opposite wall by means of an 
artery forceps. .\n artificial ulcer was produced 
by denuding the mucosa down to the muscular 
layer. The edges of the stomach incision were 
likewise denuded, thus creating two artificial 
ulcers on opposite sides of the stomach one and 
a half inch from the pylorus. This incision was 
then sutured and the abdomen closed. The dog 
was fed on the third day after the operation with 
some scraped meat containing four grammes of 
l:iismuth. Three hours later an X-ray picture was 
taken. Two and five hours thereafter other radio- 
gra]5hs were made. These plates showed bismuth 
retained above the sites of the ulcers. 

" 'This conforms with the findings of Cannon, 
that there is a temporar\- paralysis of the muscle 
at the point of the operation. Two days later a 
second series of plates were taken three, five and 
eight hours after four grammes of bismuth. 
These showed a lessened retention of bismuth 
than in the first series. A plate taken 24 hours 
after the bismuth showed retention practically 
onl\' at the site of the ulcer.' 

"The following conclusions have seemed to us 
justifiable : First, the retention of bismuth, given 
according to our method for a period over four 
hours, signifies a pathological condition other than 
mere displacement : second, the absence of the 
bismuth shadow from the stomach area, except- 



i7r. 



THE HOSPITAL BULLETIN 



ing in small isolated spots, is not due to stenosis 
or simjile dilatation, but to ulcer. 

■■\Miile we believe that a distinct advance has 
been made in ulcer diagnosis, that a valuable sign 
has been developed which, when present, will 
justify us in carrying out our treatment with 
assurance in otherwise doubtful cases, yet we feel 
that the X-ray examination should not as yet be 
looked upon as giving by itself a final verdict, but 
rather should bear weighty evidence when taken 
in conjunction with the other clinical data. 

"The X-ray examination having sliown a defin- 
ite ulcer shadow before treatment is instituted, its 
persistence or absence in later radiographs after 
the treatment should be an index of the restdt of 
such treatment, .^omc work has been done on 
this line, but our experience is too immature to 
report data of value." 



ITEMS 

\\liile it has long been recognized that the con- 
stant changing of the student body and the neces- 
sary shifting of control of the various teams of 
the University of Maryland did not tend to fur- 
ther the best interests of athletics, it remained 
to the foresight of Dr. Frederick II. \'inup. class 
of Kjoy. to agitate the advisability of the forma- 
tion of an alumni athletic association, which 
should assume control and thus assure a stable 
management. With this purpose in view. Dr. 
Irving J. Spear, class of 1900. president, called a 
meeting of the Adjunct Medical Faculty in 
Davidge Hall on October 10 for the purpose of 
considering the advisability of such a step. The 
consensus of opinion of those present was thai 
an atJiletic alumni association should be organized, 
and in order to carrv out this object Dr. I. J. 
Spear was elected temporary chairman, and Dr. 
Xathan W'inslow. class of npi. temporarv sec- 
retary-treasurer. 

The cliair appointed Drs. K. (ierald W'illse. 
class of ifjocj: Robert L. Mitchell, class of 1905. 
and Homer Ulrich Todd, class of i<;o8. a com- 
mittee to formulate by-laws for a permanent or- 
ganization. At a subsequent meeting the tem- 
porary officers were made permanent, and .Mr. 
Edgar .\llan I'oe. the .\ttorney-General elect of 
tlie State, was elected vice-president, and Dr. 
Robert Levis Mitchell, class of 1905. graduate 
manager of athletics. The officers have deter- 
mined to have the association incorporated, and 



also to petition the Board of Regents for author- 
ity to act as their official representative in mat- 
ters pertaining to athletics. 

It is not to be understood that the .\hmini 
Athletic .\ssociation desires or intends to infringe 
upon the students' rights, its chief function being 
merely supervisory in character, the regulation of 
team membership and the control of the financing 
of the several athletic teams. 

As heretofore, the students will have an athletic 
association of their own. which is. however, to 
occupv a subsidiary jjosition to the Alimini Ath- 
letic -Association. The undergraduate athletic 
association will elect their own officers and man- 
agers, and arrange their own schedules on the 
advice of the graduate manager of athletics. 

As an avenue for open intercourse between the 
student and alumni athletic as.sociations. the by- 
laws provided for the formation of an Alumni 
Athletic .Vdvisory Council, which is to be com- 
posed of the officers of the .Mumni Athletic Asso- 
ciation and four re]5resentatives ( one from each 
department of the school ) from the undergrad- 
uate association. This council is the court of last 
resort concerning the eligibility to team member- 
ship, games to be played, guarantees to be offered 
and accepted, schedules, etc. 

It is the hope of those interested that at last 
athletics at the L'nivcrsity have been placed on a 
firm basis. 

Membership dues are fi.xed at Si per annum, 
and all members are given a card granting free 
admittance to all games played in Baltimore un- 
der the auspices of the Association. Those de- 
siring to become members may send their names to 
the secretary -treasurer. Dr. Xathan \\'inslow, 608 
Professional Building. Baltimore. 



Dr. lulson W. ("ilidden. Jr.. class of 1907, for- 
merly superintendent of the Ueorgia State Sani- 
tarium, was a recent visitor to the University 
Hospital. 



Dr. Louis Miner Allen of \\'inchester. \'a., 
formerl)- associate professor of obstetrics in the 
University, was a recent visitor to the L'niversity 
Hospital. 



Drs. Randol])h W'inslow. class of if^73: L. 
Ernest Xeale. class of 1881 ; Robert Parke Bay, 
class of 1905; E. H. Kloman, class of 1910. and 
.\li)ert Hynson Carroll, class of 1907, attended 



THE HOSPITAL BULLETIN 



177 



the second annual session of the Clinical Conu;ress 
of Snrsjeoiis of Xorth America, held in I'hiladel- 
jihia. Xovenihcr 7 to 16, lyii. 



The foUowinj;- graduates of the I'niversity of 
Maryland are members of the United States I'uh- 
lic Mealth and Marine Hospital Service, and are 
stationed as follows: 

James C. I'erry, class of 1885, Ancon, Canal 
Zone. 

James A. Xydegger, class of 1892, New York, 
New York. 

Rupert lilne, class of 1892, San Francisco, Cal. 
(Epidemic duty.) 

1 lenrv W. Wickes, class of 1892, Cairo, 111. 

John McMuUen, class of 1895. Immigration 
Service, Baltimore, Md. 

E. H. Mullan. class of 1903, Immigration 
Service, Ellis Island, New York, N. Y. 

Lawrence Kolb, class of 1908, Reedy Island 
Quarantine Station, Port Penn, Del. 

Julian Mason Gillespie, class of 1910, Honolulu, 
Hawaii. 



Dr. Gilbert Tyson Smith, class of i8()7, has been 
appointed by the Canadian Government medical 
supervisor of the Indian village at Rampart 
House, where an epidemic of smallpox is raging. 
Dr. Smith has been for some months with the 
Alaskan lioundarv Survev. 



Dr. Newdigate Moreland Owensby, class of 
1904, was formally installed as superintendent of 
the Maryland Homeopathic Hospital, Baltimore, 
September 16. 



The following letter has been received by Prof. 
Randolph Winslow from Dr. Ejnar Hansen, 
class of 1904, of 221 W. 57th street. New York: 

"Dear Dr. Jl'inslozi.': 

"I should have answered your letter long ago. 
but I have been in bed for the last two weeks with 
a bad knee. I was making a call on a steamer 
when I stepped on a piece of wire rope and dislo- 
cated my kneecap. I am sure when Shipley hears 
that lie will say to himself: 'Well, well; Hansen 
on a steamer, a bad knee : I suppose that the 
breakfast was a good one.' Please tell him that 



the accident ha])pened before breakfast, and I 
am now beginning to get up a little every day, 
and by help of crutches I can make my way 
to my office a couple of times a day. 

"1 see in Thk Bui.i.etin only one of the class 
of i<;o4 contributing to the fund. I think it a 
very poor result. VVe were rather a large class. 
I am sending you a small check, and only wish all 
the rest would do the same, (iive my best regards 
to old friends who still remember me. 
"Vours sincerel}', 

"Ej.\'.\R H.WSEN. 

"WHiere is Hugh Brent? .Still in South 
.Vmerica?" (See page .171.) 



Dr. John .Vldridge Gibson, class of 1911. of 
Leesburg. \'a., sent us a photograph of his new 
home, which has just reached completion. The 
house is built of concrete, two and a half stories 
high, with a big hospitable-looking Colonial porcli 
in the front and a handsome Colonial doorway 
leading into the house. 



Dr. J. Frank Crouch, class of 1890, has re- 
nioved his office to 513 N. Charles street. 



Dr. James M. Craighill, class of 1882, clinical 
professor of medicine in the University of Mary- 
land, has removed his residence and offices to the 
Walbert, Charles street and Lafayette avenue. 
I"or many years Dr. Craighill has been one of the 
most prominent and successful physicians in Bal- 
timore, and has always taken an active interest 
in every movement for the betterment of the Uni- 
versity of Maryland. 



VVe are much indebted to Dr. G. Lane Taney- 
hill, class of 1865. for the kindly assistance given 
in the preparation of the account of Dr. John Reese 
Uhler's life. In the skin-grafting operation re- 
ported therein Dr. Tane\hill killed the mice and 
(lid all the mice skin-grafting himself. Then both 
Drs. Tanexhill and Uhler gave skin from their 
own arms, the scar of which Dr. Taneyhill still 
bears. 



The (leneral .\lumni Association will hold its 
annual banquet on Monday, November 13, at 7.30 
I'. M., in the Hotel Rennert. .\ business meeting 
for the election of officers will precede the ban- 
quet, this being called at 7 P. M. Governor 



178 



THE HOSPITAL BULLETIN 



Crothers ; Mayor Preston ; Prof. C. Alphonso 
Smith, the Edgar Allan Foe i^rofessor of the L'ni- 
versity of \'irginia ; Mr. J. Walter Lord of the 
Baltimore bar; Mr. T. Scott Offutt of the Towson 
bar and Air. Carl Schon, entertainer, have prom- 
ised to attend, and the evening promises to sur- 
pass anything that has ever been given by the 
General Alumni Association. 



De Sales Chappelier. class of 1904, of Lewes, 
Delaware. 



We are glad to report that Dr. Charles W. 
tamous, class of 1901, of Street, Md., was elected 
to the Hottse of Delegates from Harford county 
on the Republican ticket by a vote of 2638 and a 
majority of 282 over his Democratic opponent — 
Sullivan. As Harford is an old Democratic 
stronghold, and as Dr. Famous was the only Re- 
publican winning election in that county in the 
election just passed, we consider his selection by 
the people a high tribute to his personality. 



Amongst our Alabama alumni are : 

William Groce Harrison, '92, Empire Building, 
Birmingham. 

Howell Towles Heflin, '93, io9>-2 N. 20th 
street, Birmingham. 

Devotie Dennis Jones, '72, Woodlawn, Bir- 
mingham. 

E. Lawrence Scott, '06, Bissell. 

Lewis Green Woodson, '87, 1326 S. 19th street, 
Bissell. 

Thomas Jefferson Powell, '66, Childersburg. 

Eugene Walker Hart, '91, Walnut Hill, Dade- 
ville. 

James Columbus Cousins, '91, Equality. 

Andrew Lee Wynn. '80, 5th street, Florala. 

H. R. Bell, '79, Pansey. 

William Gibson Floyd, '85, Roanoke. 



Dr. Norman McLeod Heggie, class of 1902, 
of Jacksonville, Fla., has been quite ill with 
typhoid fever, but is now much improved, though 
he is not yet able to be up. 



Among the recent visitors to the University 
Hospital are Drs. Charles Edward Terry, class 
of 1903, of Jacksonville, Fla. ; Benjamin H. H. 
Hubbard, class of 1895, of Whitestone, \'a. ; 
Charles Wesley Roberts, class of 1906. of 
Douglas, Ga. ; Russell Wesley Raynor, class of 
1908, of Whitehaven, Md. : Harry C. Chappelier, 
class of 1897, of Hughesville, Md., and Frederick 



Dr. Wilbur Pledge Stubbs, class of 1905. who 
has been ill at the University Hospital, has suffi- 
ciently recovered to be able to go to his home, 
1504 Hollins street, Baltimore. 



Dr. Henry B. Gantt, class of 1880, of Millers- 
ville, Md., who was a patient at the University 
Hospital with an infected hand, has sufficiently 
recovered to return home. 



Dr. Nathaniel Garland Keirle, class of 1858, 
director of the Pasteur Institute of Mercy Hospi- 
tal and city post-mortem physician, reached his 
eightieth birthday on October 10. Dr. Keirle put 
in the day hard at work, healthy and vigorous as 
ever. 



Amongst our Tennessee alumni are : 

Arthur J. Edwards, '99, 210 Solar street, 
Bristol. 

Landon H. Gammon, '92, Bristol. 

W^illiam Russell Rogers, '01, Bristol. 

William A. Dietrick, '79, Miller Building, 
Chattanooga. 

John Thomas Shepherd, "74, Loveman Build- 
ing, Chattanooga. 

John S. B. Woolford, '96, 313 Chamberlain 
avenue, Chattanooga. 

John J. Harwood, '99, Halls. 

Ellcanah Zion, '88, Kodak. 

Samuel Lee Edwards, '99, Randolph Building, 
Memphis. 

^^'m. Caldwell Bilbro, '84, Murfreesboro. 



BIRTHS 

October 9, 191 1, James Dawson Reeder, Jr., 
son of Dr. James Dawson Reeder, class of 1901, 
and Mrs. Reeder, 639 N. Fulton avenue, Balti- 
more, Md. 



MARRIAGES 

Dr. Emil Heller Henning, class of 1908, was 
married to Miss Caroline D. Kinstendorflf of Ham- 
ilton and Carter avenues, Hamilton, Md., at the 
parsonage of Grace Evangelical Lutheran Church, 
Hamilton, on November 7, by the pastor. Rev. 
O. C. Mees. Dr. Henning served for a time as 
resident ])hysician at Bayview Hospital. The 
couple will make their home with the bride's par- 



THE HOSPITAL BULLETIN 



179 



cuts. Mr. and Mrs. Augustus Kinstendorff, al 
1 laiiiiltoii. 



Dr. Roscoe Conkling Metzcl, class of 1905. and 
Miss Daisy L. Mines, daughter of the late Wil- 
liam M. antl Mrs. .\nna Webster 1 lines, of lielair, 
Md., were married in the parlors of Strawbridge 
.Methodist Episcopal Church, Baltimore, (Jctober 
K), 191 1. 

The wedding was attended by the immediate 
families only. The attendants were Miss I'essie 
Gore of tilyndon and Messrs. William M. Nines. 
brother of the bride, and Thomas 15. and Olin 
Metzel, brothers of the groom. The couple will 
reside at 11)03 ^^^- North avenue, Baltimore. 



Dr. Thomas J. Talbott, class of 1895, ^"<^1 Mrs. 
Mary Garland, both of Baltimore, were married 
October 9, 191 1, at Memorial Protestant Episco- 
pal Church by Rev. Dr. William Page Dame. 
Mrs. Carland is a daughter of the late Carroll 
Bradford of Baltimore. The couple left for a 
Northern trip, and upon their return will reside 
at 642 W. North avenue, Baltimore. 



DEATHS 

Dr. John Reese Uhler, class of 1861, died at 
his home in Baltimore, 1531 McCulloh street, on 
October 9, 191 1. 

Dr. Uhler was one of the best-known surgeons 
in Baltimore, and it was as a Baltimore physician 
that he attained fame all over the country. He 
was born here May 3, 1839, the son of George 
W. and Anna M. Reese Uhler. He attended a 
private school in Baltimore, and then studied 
pharmacy at the Maryland College of Pharmacy. 
He afterwards studied medicine at the University, 
graduating in 1861, his course of studies there be- 
ing under the teachings of Profs. Samuel Chew. 
Christopher Johnson and Edward Warren. 

In 1862, during the war, Dr. Uhler, who had 
begun the practice of medicine in this city in 
April, 1861, was made acting assistant surgeon in 
the United States Army. It was while in this 
service that he discovered a method of telling 
whether a ball was lodged in a person's body be- 
fore probing for it. This was before the porcelain 
or Garibaldi probe was in use on the field. In 
1864 the young physician was commissioned sur- 
geon of the Eifth Maryland Volunteer Infantry, 
serving with this body until the close of the war. 

In 1867 Dr. Uhler was appointed resident phys- 



ician at Bayview Asylum, remaining there until 
1868, when he went abroad. He took a post- 
graduate course in the lectures and a laboratory 
course at King's College, in London, later taking 
a further laboratory course at Johns Hopkins 
LTniversity and at Johns Hopkins Hospital. 

In 1869 Dr. Uhler; in conjunction with Dr. G. 
Lane Taneyhill, class of i8()5. performed what 
was probably the first skin-grafting operation in 
Baltimore. A horse car ran over a boy named 
B. E. Miller, crushing his body and tearing the 
flesh from his left hip, and causing serious inter- 
nal injuries. Dr. Taneyhill had the case, and 
called Dr. Uhler into consultation. Dr. Taneyhill 
performed by himself the grafting of skin from 
mice upon the patient, killing the mice himself. 
Dr. Taneyhill thus describes it : 'T secured 8 
nidi (out of the 13 I grafted), and they made a 
beautiful cluster of islands. Dr. Uhler and my- 
self also gave skin from our own arms." The boy 
finally regained perfect health. 

In mentioning Dr. Taneyhill, we may add that 
Drs. Uhler and Taneyhill served together in the 
Union Army. 

Besides being one of the founders of the Bal- 
timore Medical College, Dr. Uhler at one time 
served as professor of surgery and as professor 
of chemistry at that institution. He was a mem- 
ber of the American Medical Association, the 
Aledical and Chirurgical Faculty of Maryland, 
one of the founders and at one time president of 
the Baltimore Medical Association, a member of 
the Maryland Academy of Sciences, the Surgical 
Society of Baltimore, the Pathological Society of 
Baltimore and one of the founders of the Clinical 
Society of Baltimore. 

He was also a member of and at one time a re- 
gent of the Royal Arcanum, and an active member 
of the Independent C)rder of Heptasophs. Dr. 
Uhler is survived by one daughter (Miss Grace 
Elma I'hler), two sons (Messrs. John Ridgely 
and Allan Hamilton LThler), three sisters (Misses 
Mary A., Georgia and Miriam Uhler) and two 
brothers (Dr. Philip Uhler, provost at Peabody 
Institute, and Mr. Harvey Uhler). 

Interment was in Greenmount Cemetery. Drs. 
Taneyhill, Carville V. Mace, class of 1897, and 
Wilbur Phelps Alorgan, class of 1862, served as 
pallbearers. 



Dr. Napoleon B. Nevitt, class of 1857, died at 
his home in Accotink, Ya., September 25, 191 1, 



i8o 



THE HOSPITAL BULLETIN 



aeed 8i. He served dnrins; tlie Civil War as a 



Confederate surgeon. 



Dr. Lawrence Sterling Alexander, class of 
t868, died at his home in St. Augustine. Fla , 
November 6, 1910, from heart disease, aged 68 
years. 



Dr. Oliver J. Gray, class of 1902, died at his 
home in Wilmington, Del., September 29, 191 1, 
of pneumonia, aged 31 years. 



We have learned of the recent death of Dr. 
George Edward Gilpin, class of 1882, of Berkeley 
Springs, W. \'a., aged 65 years. 



BOOK REVIEWS 

The P.\r.\sitic Ami-:ba of Man. By Charles F. 
Craig, M. D., Captain, Medical Corps, United 
States Army. From the Bacteriological Lab- 
oratory of the .\rmy Medical School, Wash- 
ington. D. C, and the Rockefeller Institute 
for Medical Research, New York City. Pub- 
lished with the authority of the Surgeon- 
General of the United States Army. Phil- 
adelphia and London : J. B. Lippincott Com- 
pany. Cloth, $2.50 net. 191 1. 
The literature on amebic infections in man has 
been so scattered that a person desiring any in- 
formation on the same had to wade through a 
mass of material to worm out that which he sought. 
Thanks to the energy of Dr. Craig of the 
United States Army, this is a thing of the past. 
Now all one has to do is to consult Craig's "Para- 
sitic Amebe of Man," where can be found the life 
history, general morphology, classification and 
nomenclature, the ameba of the intestinal tract, 
of the mouth, of the genito-uninary tract and those 
occurring in exudations, abscesses and in the 
lungs. The book is well written and in a pleas- 
ant style. The contents have added value, in that 
they are not merely a compilation of what others 
have written, but a resume of actual contact with 
the affection and laboratory experiments carried 
on by the aiuhor in the bacteriological labora- 
tories of the .Army Medical School and the Rocke- 
feller Institute. Unlike many iniblications, it is a 
distinct addition to medical thought, and should 
be found of material benefit to bacteriologists, 
teachers, students, internists and surgeons. 



Intern.vtion.vl Clinics. A Quarterly of Illus- 
trated Clinical Lectures and Especially-Pre- 
pared Original .\rticles on Treatment, Medi- 
cine, Surgery, Neurology, Pediatrics, Ob- 
stetrics, Gynecology, Orthopedics. Pathol- 
ogy, Dermatology, Ophthalmology, Otology. 
Rhinology, Laryngology, Hygiene and Other 
Topics of Interest to Students and Practi- 
tioners. By leading members of the medical 
profession throughout the world. Edited by 
Henry W. Cattell, A.M., M.D., Philadelphia, 
U. S. A. With the collaboration of Wm. 
Osier, John H. Musser. A. ]\lcPhedran, 
I-Vank Billings, Charles H. Mayo. Thos. H. 
Rotch, John G. Clark, James J. Walsh, J. W. 
Ballantyne, John Flarrokl, Richard Krctz. 
With regular correspondents in Montreal. 
London. Paris, I'.erlin, Vienna, Leipsic. 
Brussels and Carlsbad. \'olume III. 
Twenty-first series. Philadelphia and Lon- 
don : J. B. Lippincott Company. Cloth, $2 
net. 191 1. 
The alert physician nuist have literature on the 
several specialties, internal medicine and surgery 
if he expects to keep abreast of the times. This 
can be obtained in various ways, but generally 
only after wading through a mass of unreliable 
material. In order to obviate this useless waste 
of time, the Lippincott Company has been issu- 
ing for a number of years absolutely trustworthy 
articles from the pens of recognized authorities. 
The present volume is no exception to its pred- 
ecessors, in that it contains the latest and best 
thought on questions of vital interest to specialist 
and general practitioner. The fields of thera- 
peutics, medicine, surgery and the other 
branches of medicine are all represented by 
articles by distinguished men. Some of the con- 
tributors to the present volume are Harlow Brooks 
' "The Modern Treatment of .-^rterio-Sclerosis"). 
James J. Walsh ("Heart Therapeutics and tlv.- 
Individual Patient"), Thomas R. Brown ("The 
Relationship Between ( Jastric and Urinary Acid- 
ity"), Paul \'. Anderson ("Physical and ^Mental 
Hygiene in the Young, With Remarks L'pon the 
Development of Dementia Precox"), F. H. Brad- 
ford ( "The Surgical Treatment of the Disabili- 
ties ]'"ollowing Anterior Polioiuxelitis"), Robert 
Jardine ( "The Retraction Ring As a Cause of Ob- 
struction in Labor"), etc. Surely from this list 
the most fastidious taste will find something to 
interest and benefit. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
IPRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md, 



Entered at the Baltimore Post-omce 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., DECEMBER IS, 1911. 



No. 10 



A HURRIED TRIP THROUGH EUROPE. 



Bv T. A. AsHBv, M.D. 



(Continued from Xovcmher Issue.) 

Our stay in Brussels was much too short to en- 
able us to visit the many places of interest there. 
The impression made upon our minds was that 
it is a very beautiful and cosmopolitan city, re- 
sembling in the character of its public and private 
buildings and its social life Paris and Berlin. The 
Royal Palace. Palace of Justice, Cathedral of St. 
Gudule, the Bourse, and many other buildings 
are large and noble structures, reflecting great 
credit upon the artistic taste and liberality of the 
people of Belgium. 

The streets of Brussels are broad and splendid- 
ly paved. They are kept thoroughly clean and in 
liiorough repair. Waterloo avenue greatly resem- 
bles Eutaw Place in Baltimore in its Central Park 
and beautiful buildings lining its broad streets' on 
both sides of the park. The park itself does not 
compare in beauty with that in Eutaw Place from 
the fact that it has no grass or flower beds but 
simply rows of trees surrounded with sand upon 
which the children and dogs are invited to play, 
the idea, perhaps, being to keep them otif the 
streets. This condition was noticed also in the 
parks in London and Paris, where thousands of 
children were to be seen romping and playing all 
kinds of games. The health and pleasure of the 
children are considered of more importance than 
green plats or flower beds. 

Brussels had a population of some 900,000. It 
is so cosmopolitan that Dutch, French, German 
and English are equally well spoken by the edu- 
cated class of people. Many of the car conduc- 
tors speak all of these languages. French customs 
and wa\s are so much in vogue that one can easilv 



imagine that he is in Paris. Brussels is a city of 
large wealth and enterprise. Its looms and fac- 
tories produce the finest carpets, tapestries, laces, 
gold and silver ware to be found in Europe. Ow- 
ing to the great heat of the weather at the time of 
our visit we were not able to see the battlefield 
of Waterloo, 30 miles distant. We learned enough 
from tourists, who had been there, to satisfy us 
that we missed very little as comparatively little 
has been done to beautify the place. 

The ride on the train from Brussels to The 
Hague in Holland was a journey of less than four 
hours, yet it was so filled with scenes and interest- 
ing objects as to make a memorable impressioii on 
our minds. Every mile of territory presented 
some new object or scenery different from any of 
my previous experiences. The country through 
which we passed was very low land cut into many 
strips by ditches and canals, which acted as sub- 
stitutes for fences. On these lowlands there were 
grazing many thousand Holstein cows and calves, 
as also horses and sheep. I counted as accurately 
as I could from the car window over 300 cows in 
one large field. All of this lowland was in pas- 
ture or hay fields. The country was very closely 
settled with villages and tovvns whilst the famous 
windmill was dotted here and there, its huge 
wings revolving under the pressure of the air, 
now slowly, now rapidly, presenting a picture only 
seen in Belgium and Holland. These great ma- 
chines do an enormous work in pumping water 
from the low canals over the dykes into the sea. 
But for the windmills much of this lowland would 
be submerged. The distance from Brussels to 
Antwerp was covered by our train in less than 40 
minutes. 

Antwerp is located on the River Schelde not 
far from where it empties into the North Sea. No 
city in Europe has, perhaps, had a more stormy 
and eventful historv. During the reitrn of Charles 



182 



THE HOSPITAL BULLETIN 



\' it was the largest seaport in the world. Its har- 
bors ami docks were alive with ships which navi- 
gated every section of the then civilized world. 
Its commerce both in exportation and importation 
was enormons.and bronght great wealth and pros- 
perity to the city and to the Netherlands. No city 
in Europe at that time enjoyed greater renown as 
a center of culture, elegance and enterprise. \\ hen 
J'hili]) II of Spain fell heir to his father's rule in 
the Netherlands he introduced the Inquisition into 
that country which lirought in a few- years com- 
plete desolation and ruin throughout Belgium and 
Holland. 

-Antwerp was among the first cities to feel the 
hand of tyranny and oppression. Her commerce 
and wealth were so completely destroyed that she 
has never regained her former position as the leader 
of commerce and as a seafaring center. Today 
she is a large and rich city, with magnificent docks 
and wharves, with an extensive commerce and 
trade, but far behind London, Liverpool, Ham- 
burg and other European seaports. 

The distance from .\ntwerp to Rotterdam is so 
short that we were hardly sensible of the fact that 
we had left the suburbs of the former before we 
were crossing the Rhine to enter the latter city. 
The intervening country is in keeping with the 
greater portion of Holland, a low, fiat land cut 
into numerous strips by ditches and canals, and re- 
claimed from the sea by numerous dykes. The 
land is too low and swampy for crops of wheat. 
rye and oats, but rich in grass, suitable for hay 
or pasturage. The Dutch farmer is, therefore, by 
necessity a dairyman antl in this occupation he 
excels, the butter and cheese of Holland having 
the highest standing throughout the entire world. 

Rotterdam is a large and wealthy seaport with 
extensive harbors, docks and wharfage, which 
are crowded with steamers and ships trading with 
countries all over the world. The city is so cut 
up with canals that it is almost disconnected hy 
its waterways, which take the place of streets. 
Rows of vessels line many of its thoroughfares, 
with drawbridges connecting its many separated 
sections. "Water everywhere without a drop to 
drink" was an observation made by a ])assenger 
on our train. This seemed literally true not only 
of the whole of Holland but of nearly every place 
we visited in Euro])e. ( )n the railroad cars no 
water fit t(i drink can be had. It is an unknown 
lu.xury in luirope. 1 did not see a single ice cool- 
er in a railroad car, depot, hotel or public build- 



ing in Europe, nor in a single place of business. 
It was next to impossible even to buy ice water in 
the hotels. I confess I paid more for ice water 
than for all other drinks, and 1 suffered more 
from thirst than from any other discomfort. Peo- 
ple who drink only wine, beer, ale and bad water 
know none of the pleasures that come to one who 
drinks only pure ice cold water. Rotterdam is 
known best as the place where Holland gin is dis- 
tilled and I presume its people drink gin as a sub- 
stitute for water, as the Germans drink beer and 
the French wine. .As an American I prefer pure 
ice water. The ride from Rotterdam to The 
Hague is through a low, flat country intersected 
with numerous ditches and canals and used al- 
most entirely for pasture. The herds of beautiful 
cows we saw would make an American dairyman 
covetous. 

We reached The Hague about noon and were 
driven to the Hotel Belmont, where we found 
most comfortable accommodations. The clerks, 
waiters and employes in this hotel speak English 
so well that it is chiefly patronized by those who 
speak the English language. After lunch we lie- 
gan our usual tour of inspection and saw the 
larger portion of the city before we retired for 
the niglit. 

The Hague is a city of over 250,000 people. As 
the capital of Holland it is the most fashionable 
city in that country. It is said the Dutch people 
make their money in other localities and speni! 
it at The Hague. The older sections of the city 
are ugly and quaint ; the modern sections are 
handsomely built up. The Hague is built on very 
low ground and is cut up with the usual Dutch 
canal and ditch. It is located in a dense forest 
once owned by the counts of Holland. These 
forests still stand as a great park with their old 
trees and ditches around which the city has been 
buih. 

The palace of the Queen, known as the Palace 
in the Woods, erected before Columbus discov- 
ered America, stands in the middle of this great 
park. The house, built of brick, is large but a 
very plain structure exteriorally. I'pon the pay- 
ment of 25 cents we were conducted through the 
building by a woman guide who spoke indift'erent 
English. The various rooms are very handsome 
and are furnished most beautifully with antique 
chairs, tables, bric-a-brac and tapestries. 

Two rooms, one furnished by a former Em- 
peror of Japan, and the other by an Empert)r of 



THE HOSPITAL BULLETIN 



183 



Cliina, contain the most lieanlitul ])orcc'lain and 
cliinawarc I have ever seen, with other works of 
art, showiui^ the sjreat artistic workmanshi]) of 
these jieople. In the center of the palace is a 
lart;e circular room crowned with a dome. On 
the walls and dome is an allej^orical ])aintin}j rep- 
resentins;' the birth, infancy, childhood and man- 
hood of one of the former kings of Holland. This 
great painting was made over 300 years ago by 
Dutch artists who were the pupils of Rembrandt 
and Rubens. It was stated by the guide that some 
si.x painters were emjiloyed for seven years in 
doing this work. It was so well done that today 
it looks as fresh as if it had been made only a 
few years ago. Just prior to this time blemish 
art had reached its highest plane of perfection and 
rivaled the Italian school. In the museum at The 
Hague we saw the beautiful works painted by 
Rembrandt, Rubens, Van Dyck and many others 
which today are fresh and perfect, untarnished 
In' the hand of Time. The First Dissection, by 
Rembrandt. 7 by 9 feet, hangs on the wall where 
it was probably placed over three centuries ago. 
The picture is so natural and life-like that all the 
characters stand before the eye, as living beings 
almost in the act of expressing their admiration 
and astonishment to the teacher, who is pointing 
out the anatomy of the arm which he is dissecting. 
The cadaver stretched before the pupils loses its 
ghastly expression in the intense interest which 
animates the countenances of those who stand 
around and take in the tissues laid bare by the 
knife of the anatomist. 

This art museimi in The Hague is devoted en- 
tirely to I'^lemish art. It is very rich in the work 
of the old masters and in examples which are un- 
rivaled in any section of the world. The genius, 
versatility and industry of these old artists arc 
fully illustrated in the extent, beauty and variety 
of works still in perfect state of preservation. The 
privilege of seeing these old masters will fully re- 
pay one for a visit to The Hague. There are, 
however, other objects of interest there which 
cannot fail to interest the student of history. In 
one of the public squares is a bronze statue of 
\\'illiam of Orange, of heroic size, erected by the 
people of Holland to the memory of the great 
man who founded the Dutch Republic. No char- 
acter in the world's history stands out in bolder 
relief than William of Orange. What Washing- 
ton was to our country, William was to Holland 
and Belgium. lUit far more, the principles for 



wiiich he labored and died have been of greater 
\ahie to mankind at large than the mere found- 
ing of these two prosperous kingdoms. He re- 
sisted the tyranny of the bigot and taught the 
world to recognize that liberty of conscience and 
love of truth are the foundation stones on whicli 
alone man can build a character of faith and 
righteou.sness and ho])e of eternal life. 

( )n Sunday afternoon we visitecl Scheveneng, 
which is some three miles from The Hague. It 
is located on the North Sea and is the great sea- 
side resort for the people of Holland. It is hand- 
somely built up with large and imposing hotels, 
and boarding houses, which are filled during the 
bathing season with thousands of visitors. The 
beach is a very low and sandy strip of land well 
adapted for bathing purposes. At the time of 
our trip there were thousands of people enjoying 
the surf and eating in the many cafes and eating- 
houses along the shore. Whilst Scheveneng is a 
very attractive place, it is not so large and hand- 
somely built up as is Coney Island or Atlantic 
City. 

The Hague has within recent years come into 
great prominence as the place where the Interna- 
tional Peace Congresses are held. A magnificent 
marble structure is now in course of construction 
for the use of the Peace Congress, a gift of Mr. 
Andrew Carnegie to the cause of peace through- 
out the world. Great good must come to all na- 
tions from the work of the men who are dele- 
gated to these Congresses by the great nations of 
Europe and by our own country. Let us rejoice 
in the day when nations will cease to war with 
each other, when all differences will be arbitrated 
and settled out of the court of legal murder and 
bloodshed. 

W^e deeply regretted our inability to visit the 
great L^niversity of Leyden, only some 13 miles 
from The Hague. This great school of learning 
has a most interesting history. During the strug- 
gles of Holland with Spain, the City of Leyden 
was besieged by the Spanish Army. Its people 
put up a long and brave resistance and withstood 
the pangs of starvation until reduced to a point 
where further resistance seemed impossible. Food 
could not be introduced and outside aid was de- 
s]->aired of. William of Orange^ the leader of the 
forces of Holland, suggested to the landowners 
and burgomasters of many of the smaller cities 
that the only way to relieve the siege was to open 
the dykes and turn the North Sea into the low- 



i84 



THE HOSPITAL BULLETIN 



lands. This meant a total destruction of crops 
and inundation of many homes and towns, an 
enormous loss to his countr_y. With an unselfish- 
ness which at all times had prompted the Dutch 
in tile war with Spain, the dykes were opened, the 
land was flooded and the Spanish troops were 
forced to give up the siege or be drowned like 
rats in their camps. The Spanish commander, in 
ordering a retreat, said he could fight men but 
not the North Sea. The siege was raised and 
Leyden escaped the murder and desolation which 
had been inflicted by Spanish troops on other 
cities which had to surrender to their brutality. 
In honor of this great achievement and in com- 
memoration of so great an event William of 
Orange proposed that a great university be en- 
dowed by the people of Holland. A charter was 
obtained, money was contributed by an impover- 
ished people and the University of Leyden was 
founded in the year 1574. From that day to the 
present time it has been one of the great univer- 
sities of the world. When we consider the hero- 
ism, unselfishness and intelligence of the Dutch 
people of that day we are not surprised to see 
that their descendants of our times are among the 
most cultivated and prosperous people of the 
world. 

There is so much to interest one in Holland 
that I would have gladly lingered longer in that 
country. We were compelled to live up to our 
schedule as we were booked to leave on the 
steamer for home on the following Saturday. 
Monday morning we took the train at 9 o'clock 
for Hamburg, a ride of over 13 hours. Our way 
led through Harlem, Amsterdam and other small- 
er cities, along the Zuyder Sea for many miles un- 
til we reached the higher lands of East Holland. 
The railroad bed was over a low land across nu- 
merous canals and along the borders of the great 
dyke which keeps the waters of the sea from flood- 
ing a large section of Holland. As our car 
passed along the site of the great dyke we could 
sec sailing vessels on the sea lifted many feet 
above the window ])resenting a most unusual but 
an attractive ]iicture. For many miles we fol- 
lowed the sea walled in by human lalaor and forced 
back from the lands which at one time made its 
bed where thousands of cattle are now grazing. 
It is said the pco])le of Holland have spent over 
$[,500,000,000 on its dykes and that the annual 
exijense of maintaining these dykes is over $2,- 
000,000. As large as these figures appear to be 



the land recovered from the sea and brought into 
use has more than repaid for the outlay. 

In a country so densely populated as Holland 
(some 400 to the square mile), every acre of 
ground has a value and must be made to yield 
profitable returns. This would seem to be the 
case, for the Dutch farmer is a prosperous and 
well-to-do man — industrious, painstaking and up- 
to-date in management of his land. 

The Dutch people are proud of their heritage 
and devoted to their countn,'. By toil and skill 
they have made a great lowland, half marsh, half 
swamp, one of the most prosperous sections of 
the world. 

The eastern section of Holland through which 
\vc passed is elevated and somewhat rolling, and 
here wheat, rye, oats, potatoes and beets are large- 
ly cultivated. I saw fevv fruit trees or orchards 
from the car window. As we were traveling to- 
ward the border line of Germany the conductor 
on the train, in answer to our questions, became 
very communicative and pointed out a number 
of interesting objects. He spoke fairly well Dutch, 
P'rench, German aufl English, and explained to 
us that all of these languages were taught in the 
public schools of Holland and that railroad con- 
ductors were required to speak them on account 
of ihe enormous travel of foreign people over the 
railroads of Holland. As a conductor, a man of 
more than common intelligence, he received only 
one dollar a day. On this sum he supported a 
wife and four children and lived as he expressed 
it "well". The small wages paid railroad em- 
ployees in Europe is in striking contrast with those 
received by the same class in this country. In 
spite of the fact that all the European countries 
are crowded with people and that much of the 
food supplies is brought from foreign countries 
the cost of living is much cheaper in Europe than 
here. This is due to the fact that the laboring 
and even well-to-do classes eat much less, are 
less wasteful and much better cooks. Earning 
much less, they save more and are more thrifty 
and I believe more contented than our people. 

I was both pleased and disappointed with my 
ride through Germany. In some sections the 
farm lands are in a high state of cultivation and 
the cnuntry is very picturesque. In other sections 
the lai?d is poor, liarren and sparsely settled. It 
was after 10 o'clock at night when we arrived at 
the .Atlantic Hotel in Hamburg. After a contin- 



THE HOSPITAL BULLETIN 



i8s 



uous ride of 13 lioiirs wo were very tired and soon 
found rest in sleep. 

Tlie following niorninq; we were joined by Rev. 
Dr. A. C. Rubenstein, of our city, who had crossed 
the Atlantic with us and had parted with us and 
journeyed on from London by another route. As 
he iiad secured rooms for us at the Berliner Hof 
we moved to that hotel and made it our headc|uar- 
ters during- our stay in Hamburg. After breakfast 
we went to Thomas Cook&Son's for our mail and 
ne.xt to the offices of the Hamburg-. \merican Line 
to arrange for our return passage. These two im- 
portant matters attended to Mr. Page and f took 
a taxi to see the city. Hamburg is a city of over 
900,000 people and one of the richest and most 
progressive cities in Europe. Next to London it 
has the largest tonnage of any seaport in the 
world. Located on the Elbe, 6o miles from the 
North Sea, its docks and shipbuilding companies 
are land-locked and secure from storms and tidal 
influence. 

Tile number of steamships and sailing crafts 
coming to its liarbor is so large that miles of 
wharves are needed for loading and unloading. 

The Llamburg- American Line, owned by Ham- 
burg capital, w^ith its general offices in that city, 
has over 450 ocean steamers engaged in foreign 
trade. Not only in commerce but in all lines of 
business, insurance and banking, Hamburg does a 
very extensive work. The business section is built 
up in a most substantial way, but its beauty and 
wealth are best shown by its residential sections. 
The city is built around a large body of fresh 
water, known as Lake Austen, which averages one 
mile in width and some five miles in length. A 
broad avenue surrounds this lake, and fronting on 
this avenue are the most palatial business and pri- 
vate buildings I saw in Europe. The homes of 
the people of wealth fronting on this avenue are 
of the most attractive designs and ornamentation. 
They set back in yards filled with flowers and 
shrubbery, with porches and windows concealed 
by the rambler rose, climbing vines, geraniums 
and blooming flowers of every description. The 
effect of this wealth of floral decoration is very 
striking to one who lives in a city where flowers 
are seldom found except in parks and backyards. 
There is one enterprise in Hamburg which must 
be seen to be appreciated. This is Hagenback"s 
Zoological Gardens. In a park of over 50 acres 
this enterprising man has collected wild animals 
from almost everv section of the world and has 



l)laced them within large enclosures where the 
natural habits of the animal are maintained as 
nearly as possible. 

Lions, tigers, bears and wildcats live in caves 
and dens: seals and jjolar bears in water and on 
rocky cliff, representing huge icebergs ; goats and 
mountain sheep climbing over large cliffs made 
of artificial stone. In these various homes there 
are animals bred in captivity and are then do- 
mesticated as much as is possible. The 1 lagen- 
1 ack (iardens draw thousands of ]jeoplc to Ham- 
burg. It has done more to advertise the cit\- than 
the immense harbor with its extended commerce. 
Wednesday afternoon Mr. Page and I took the 
train for Berlin which is about 180 miles south of 
Hamburg. The distance was covered in nearly 
three hours' time. The railroad passed through a 
level farming country and on a smooth bed the 
locomotive made nearly 60 miles an hour. We 
reached lierlin before dusk and found rooms in 
the Deutsche Hof, a small hotel but neat and 
cleanly. After dinner we secured a taxi and were 
carried over the city at fast speed for some hours. 
^^'e saw a great deal of the city, brilliantly illu- 
minated and in its gayest attire. The walks, parks, 
casinos, eating houses and places of amusement 
were filled with men, w-omen and children. Berlin 
is a very handsome city, more modern in its build- 
ings than London or Paris. Its streets, parks and 
public buildings show the energy and enterprise 
of the German people. Its rapid growth in popu- 
lation since the Franco-German War is only an 
illustration of the great progress the German Em- 
pire is now making in increase of population and 
wealth. The thrift, industry arid intelligence of 
the German people are shown on every hand and 
one has only to visit their country to realize its 
national strength. 

On Thursday morning we made a hurried visit 
to Potsdam, some 20 miles from Berlin. This at- 
tractive old place was the residence of Frederick- 
William and of his son, Frederick the Great, the 
two great rulers wdio laid the foundation of Prus- 
sia and of the German Empire. Frederick \\'i\- 
liam will be remembered in histor)' as the eccen- 
tric and parsimonious king who had a peculiar 
fancy for tall soldiers antl for a full treasury. He 
organized the best disciplined army in Europe and 
accumulated large sums of money by his frugal 
habits of administration. After his death, Fred- 
erick the Great, found both men and money at 
his command, and to make himself notorious, as 



1 86 



THE HOSPITAL BULLETIN 



he expressed it, waged war against A [aria Teresa 
of Austria to recover Silesia. This led to the first, 
second and third Silesian wars, the latter of which 
lasted seven years and came near costing Freder- 
ick his life and kingdom. Austria, France, Rus- 
sia and a number of the German states formed 
a coalition against Prussia; 100,000,000 people 
were arrayed against 5,000,000 Prussians. In the 
unequal contest Frederick was driven from pillar 
to post and almost vanquished. With a nerve 
and genius few men have ever possessed he came 
out a victor with his country ruined in fortune, 
but renowned in military prestige. The kingdom 
of Prussia then came into the front rank among 
the jiowers of Europe. Frederick Williaiu and 
Frederick the Great, his son. lie side by side in 
granite vaults in the old church erected by the 
former at Potsdam. The old buildings at Pots- 
dam are but shadows of a former glory which 
remind the visitor of the changes which time 
makes in the affairs of men and of nations. Sans 
Souci, the residence of the present Emperor, is 
located in a large park adjacent to Potsdam. We 
were driven all through the grounds and saw the 
residence of the Emperor with its gardens, or- 
chards, hot houses and stables. The palace is 
large but not pretty. It might be mistaken for 
an asylum if one was not informed as to its true 
character. The most beautiful object we saw was 
a small chapel in which lie the tombs of "L^nser" 
Fritz and his wife, Victoria, father and mother 
of the present Emperor. Over each tomb is a 
recumbent figure cut out of purest white marble, 
lifelike effigies of the deceased. 

Thursday evening we returned to Hamburg and 
Friday was given up to further sightseeing in that 
city. At 8 o'clock Saturday morning we took a 
train for Cuxhaven, 60 miles distant, where we 
stepped on board the steamer Pennsylvania for 
our return home. Whh the band playing and a 
large crowd of people on board exchanging fare- 
wells the steamer quietly moved away from the 
landing and was soon moving westward. To sav 
that I was glad to be homeward bound only half 
expresses my feelings. The voyage across the 
Atlantic was a long and tiresome one to me. The 
steamer was crowded with passengers and the 
discomforts were many. 

It was a German steamer with German cook- 
ing. This was too much for me. I could scarcely 
cat the food and could only drink the water by 
taking an acid in my mouth to disguise the taste. 



To compel the passengers to buy beer, wine or 
poor lemonade the company provided no suitable 
water. I suffered from thirst the entire trip. No 
more German steamers for me should I ever 
visit Europe again. 

My friend, Dr. Randolph Winslow, has advised 
the readers of The Bulletin to see America 
first. I saw a good deal of America before I vis- 
ited Europe, so my advice is to see both coun- 
tries. The man who sees America first will come 
back from Europe with a keener appreciation of 
his own country than he has ever had. Europe 
is an old country filled with history and monu- 
ments of human greatness. We owe much to the 
people who have made our civilization so rich in 
all that ennobles and elevates mankind. W'c all 
sprang from European soil and should feel that 
reverence which every child should have for pa- 
rental training and affection. \\'e have learned 
much and have much more to learn from our Eu- 
ropean kindred. 

When the steamer on which we returned land- 
ed at the wharf in the harbor of New York I was 
truly happy to be again on American soil. After 
jiassing the inspection of the custom house offi- 
cials where the greatest courtesy was extended, 
I secured a ticket for Baltimore over the Penn- 
sylvania Railroad, and reached my home at 5.30 
in the afternoon. We were absent from home 48 
da}'s. During this time we traveled by water and 
rail about 10,000 miles. We visited England, 
France. Switzerland, Belgium, Holland and Ger- 
many. We enjoyed almost perfect health, escaped 
accident and delay, had great satisfaction and 
jjrofitable experience, and i"eturned to our homes 
with our hearts full of love for our own country 
and our own people. 



A large and successful subscription card party 
was held on Wednesday, November 29. at the 
Hotel Emerson for the benefit of the University 
Hospital. The affair was arranged by the Ladies 
Auxiliar}-, and the proceeds donated to be used 
in tlie free wards of the Hospital. The commit- 
tee on arrangement was Mrs. Frank Martin, Mrs. 
L. Ernest Neale and Mrs. William Kelso White. 
.\niong those who assisted were Mesdames Ham- 
ilton Easter, Joseph Holland, John C. Hemmeter, 
Francis E. Waters, Samuel C. Chew, William H. 
Matthai, John K. Shaw, Jr. ; Misses Florence P. 
Sticff and Lucv Marshall. 



THE HOSPITAL BULLETIN 



187 



SEE AMERICA FIRST. 



By Randolph Winslow. 



4. SAN FRANCISCO AXD TITK liA'iSIDE CITIES. THE 

COAST LINE TRIP B.VCK TO LOS ANGELES. 

ACROSS DESERT TO SALT LAKE CITY. 

^Fy first visit to San Francisco was in August, 
iyo5, about ten months before its desolation by 
earthquake and fire ; hence my chief cu- 
riosity on this visit was to see how much it had 
recovered from its great catastro])he, ami to note 
the changes in the character and appearance of 
the reconstructed city. Enormous progress has 
been made in rebuilding the city ; and the new 
buildings are much more imposing than the old, 
and are built of ferro-concrete material, hence are 
supposed to be' both fire and quake proof. The 
city as a whole, however, has lost much of its 
oriental and foreign appearance, and does not 
differ materially from other modern American 
cities. Chinatown has been reconstructed on its 
old location, but it also does not possess the air of 
mystery as in the old days, and thecompany houses 
are better built and less insanitary than before the 
fire. Thousands of Chinese live and labor in this 
locality, and have their small shops and places of 
business here. The Sing Fat Company and the 
Sing Chong Company have huge stores where one 
can buy almost any product of the Orient, at a 
reasonable figure. Chinatown is of quite restrict- 
ed area, being about three by six blocks in extent, 
but housing many thousands of Chinese men, 
women and children, many of whom live in cel- 
lars and other unsanitary places. The situation 
of San Francisco is remarkable : with its front in 
the Bay, it extends about five miles over steep 
hills to the Pacific Ocean, and is bounded on the 
north by the narrow and deep Golden Gate, which 
connects the Ocean with the Bay. All the com- 
merce of the city passes through the Golden Gate 
to the docks and wharves on the bay side, while 
the broad Pacific beach afTords a splendid seaside 
resort right at its back door. The Cliff House, 
Sutro Baths, Golden Gate Park and the Presidio, 
the United States Army reservation, are all found 
overlooking the Western sea. In no respect has 
the resurrection of San Francisco been more mar- 
velous than in its large and fine hotels. 7'he mag- 
nificent white pile of the Fairmont Hotel crowns 
Nobs Hill, and is visible from afar. St. Francis 



Hotel, in Union Square Plaza, is also a splendid 
hostelry, as is the Palace and many others. .\s 
I had on my previous visit explored the city 
pretty thoroughly, I did not spend much time in 
relocating my former experiences, but instead vis- 
ited the towns on the other side of the Bay. In- 
cidentally I may say that the weather was raw, 
damp and cold, and though the temperature in the 
cast was over 100 degrees, and deaths from sun- 
stroke were numerous even in New York and 
Boston, here overcoats were worn with comfort 
and even fur coats were not an unusual sight. On 
the other side of the Bay, the sky was clear, the 
air l^almy and the weather like that of spring. 




In tlio hollow of this tree, in the Calaveras Gi'ove, a hunter 
and guide lived for nearly three years. It was his "roof 
tree." It 'is a one-roomed cabin, is 16x21 feet, and was some- 
times shared with his horses. The "simple lii'e," and no rent 
to pay ! 

Crossing to Berkeley, we seemed to be in a differ- 
ent country, the streets were lined with solid banks 
of brilliant colored flowers, and as far as one could 
see there were double rows of geraniums and 
other flowering plants. The bungalows and cot- 
tages, each with its separate lawn and grounds, 
flowers and vines, addsd beauty to the scene. At 
one place were a number of rocks hollowed into 
bowls by the Indians and evidently used at one 
time for grinding grain and acorns. The Univer- 
sity of California is located at Berkeley in a large 



1 88 



THE HOSPITAL BULLETIN 



reservation of about 6d3 acres. There are at 
present about 50 buildings that are sufficiently fine, 
but are considered as temporar}' and will be re- 
jilaced b)- other more elaborate structures. The 
student body numbers 3300, male and female. 

Berkeley and Oakland are directly continuous 
cities but are separate municipalities, as is Ala- 
meda, which adjoins Oakland on the south. The 
population of Berkeley is 35,000, Oakland 150,- 
000, Alameda 25,000, and Piedmont 3000, hence 
the combined population of these towns on the 
eastern shore is about one-half of that of San 
Francisco, directly opposite. They do not wish 
to be considered as the overflow of the more noted 
city, but as separate and independent centers of 
trade and commerce. The calamitv of San Fran- 



has a magnificent residence in Oakland, which is 
one of its show places. At both Los Angeles and 
Oakland there are ostrich farms where the birds 
are bred for their plumage. The ostrich is an lui- 
gainly bird, of not very amiable disposition, which 
renders it unsafe for one to attempt an_\- familiari- 
ties. In one respect at least they are said to differ 
from human beings : they are monogamous and 
mate but once. The little town of I'iedmont is 
also a very active place, and, though a new settle- 
ment, has a fine park and an art gallery contain- 
ing many masterpieces of painting, of which any 
cit}- might be proud. Alameda is situated on an 
island separated from Oakland by an estuary, and 
is a fine residential town, with a beautiful water 
front and streets lined with fine shade trees. In 




ElNCAr.OWS IX WIXTKIt. .MrUAlIAI!. CAI^. 



Cisco was the opportunity of these towns ; but 
while the former has more than regained her pre- 
vious population, the east side towns have held 
their own and are increasing at an enormous rate. 
Oakland is an especially hustling city. It is en- 
gaged in many. civic improvements, such as re- 
claiming a large area of water frontage by filling 
U]i the shallows of the bay ; the enlargement of the 
harbor, erection of public buildings and the ini- 
provement of the streets. W'lio has not heard of 
Twenty Mule Team liora.x. and who has not seen 
fabulous lookingpicturesof the twenty mule teams 
hauling huge wagons filled with borax from the 
dusty desert? This is, however, no fable, and the 
facts were as depicted. A man named Smith, and 
now known as Borax Smith, discovered the de- 
posits of almost pure borax in Death \^alley, and 
'las made an ennrmous fortune therefrtjni. lie 



the opinion of the writer any of these east side 
towns are much more desirable as places of resi- 
dence than is San I'rancisco. On July 6 we again 
took to our special train on the Coast Line of the 
Southern Pacific Railroad. Leaving the metrop- 
olis, we skirted the western shore of the I'.ay, 
])assing through Palo Alto, the home of Leland 
Stanford, Jr., I'niversity, the tops of whose build- 
ings could be seen in the distance, and thence over 
a rather steep mountain range to the lii.g Trees 
near Santa Cruz. This is a grove of giant red- 
woods — sequoia sempervirens — some of them over 
300 feet tall and from 53 to 63 feet in circumfer- 
ence. The trees are named after distinguished 
persons, as General (Irant, General Sherman, 
President Roosevelt and others, or are designated 
by names indicating their characteristics, as the 
(iianl. Jumbii and the Cathedral. They are snp- 



THE HOSPITAL BULLETIN 



i8y 



piiscd to he from 4000 to 5000 years okl, and many 
(if them iiave become IioUow, and frecjiiently the 
interior lias been eaten ont liy fire, wliicii, iiow- 
ever, is said to preserve them. They rise straight 
in the air for lOO feet Ijefore giving; o(f a lirancli, 
and then the branches are numerous and the fo- 
hage abundant. They are coniferous trees with 
cones resembUng- those of the ordinary iiine. .Many 
persons could take refuge in one of these Imnow 
trees in case of stress, and find protection from 
the storm. Si.x miles from the Big Trees is Santa 
Cruz, the ".Vtlantic City of the I'acific Coast," 
which is San hVancisco's most popular seaside re- 
sort. We now ran along the shore of Monterey 
liay to Del Monte, where is the celebrated hotel 
of the same name. This magnificent and commo- 



pine trees in the same locality are straight. The 
ostrich tree is es])ecially grotes(]ue and at a dis- 
tance resembles this huge bird. Leaving Del 
Monte our next stop was at I'aso Robles Hot 
Springs, where there are stinking sulphur springs 
that are sui)])Osed to be beneficial for gouty and 
rheumatic conditions. The smell was enough for 
me, and I did not desire any closer acquaintance 
with the water, either internally or externally, 
though some of the party went into the swim- 
ming pool and were considerably depressed there- 
by. Early in the morning of July 8 our train was 
stopped at Point Concepcion to allow us to see the 
wreck of the steamship Santa Rosa, which had 
gone ashore in a fog the previous day, and had 
broken in half. One hears of shipwrecks and the 




•■GEN. (JI!.\.\T- 



r.ii;--ii!i:i-; ckhve. sant.\ crtz, cal. 



dious hotel is surrounded by beautiful grounds 
in which are a profusion of brilliant flowers and 
rare plants and trees. One would willingly linger 
longer at this lovely place, but our time was lim- 
ited. The old city of Monterey, the first Spanish 
capital of California, is nearby. Here is the old 
San Carlos ^lission. redolent with memories of 
I"ra Junipero Serra, the pious monk who did so 
much to plant the cross and civilize the natives 
of this ])ortion of the ^\'estern Coast. I'ish are 
so plentiful here that they are caught by letting 
down unbaited hooks and allowing them to be- 
come impaled on the hooks. A beautiful drive 
along the sliore is especially interesting on account 
of the large number of cypress trees, often of 
grotesque form, and either lying flat on the 
ground or greatly inclined. I presume it nuist 
be due to the push of prevailing winds, though 



breaking of the ship, but it is not often that one 
has the opportunity to see such a disaster from a 
safe and near-at-hand point of view. The ship 
did not seem to be more than a few- hundred yards 
away, and many of the castaways were still en- 
camped on the beach awaiting transportation. 
Pursuing our journey we reached Santa Barbara, 
where we spent the rest of the day. \Miile Santa 
Barbara is not a very handsome town, it is at- 
tractive. It fronts on a crescentic bay and has a 
fine beach. There are fine hotels, especially the 
Potter and the Arlington. The climate is delight- 
ful and the bathing good. The .Santa Barbara 
Mission is located here and is the best preserved 
of the Spanish missions. Monks who wear brown 
gowns fastened with a rope around the waist, and 
sandals on the feet, guide you through the build- 
ing and grounds. Incidentally they sell curios 



190 



THE HOSPITAL BULLETIN 



and relics of various kinds. From Santa Bar- 
bara we journeyed back to Los Angeles in the 
niajht. switched to the San Pedro, Los Angeles 
and Salt Lake Railroad, and began our return 
trip across the continent. Our immediate des- 
tination was Salt Lake City, 781 miles distant 
from Los Angeles. All day July 9 we traveled 
across the desert of Lower California and Nevada. 
The country was barren, the soil alkaline, vegeta- 
tion scant, and water scarce except when pumped 
from artesian wells. The towns were few and 
far between and were of the typical Western 
style, rendered famous by Frederick Remington 
and others. Frame shacks with high fronts and 
possibly a porch, mostly devoted to rum selling 
and gambling. The temperature was 120 degrees 
in the shade and like the blast of a furnace, but 
as a matter of fact there was no shade except in 
the unshaded houses. At one of the wayside sta- 
tions I spoke to a rather rough looking man sit- 
ting on a box, who said he had come from P)alti- 
more and had been living in the desert for eight 
years and liked it very well. He said he kept a 
livery stable and also had a ranch. I did not 
think there would be any demand for teams in 
such a forlorn country, but he said he had sent 
out two that morning. In the evening we 
reached a better country and crossed a mountain 
range, and early the next morning were running 
along the southern shore of the Great Salt Lake 
and arrived at the Mormon capital about 8 o'clock. 



ECHINOCOCCUS CYST OF LIVER— SYMP- 
TOMS AND SURGICAL TRE.\TMEXT. 



By B. J. AsPKR, 
Senior Medical Studeiif. 



The tenia echinococcus, in its adult form, occurs 
in the upper part of the intestine of the dog, less 
commonly of the wolf and jackal. The mature 
worm is from 2.5 to 5 mm. in length, and consists 
of four segments. The first segment, or head, is 
provided with four suckers and a rostellum bear- 
ing from two to four dozen booklets in a double 
row. The second segment is somewhat smaller, 
ami the third considerably larger than the heail. 
The fourth is the largest of all, constituting from 



one-half to two-thirds of the entire worm. It is 
in this segment that the uterus of the parasite is 
situated, this uterus consisting of a median por- 
tion with a few lateral branches, and containing 
about 5000 eggs. 

These eggs, deposited usually in water or on 
vegetables, or conveyed by tactile communication 
from the body of the lower animal serving as their 
host, reach the mouth of man. In the stomach 
or intestines the embryo is liberated by the solu- 
tion of the egg capsule by the action of the diges- 
tive juices, bores its way through the mucous mem- 
brane of these portions of the digestive tract, thus 
reaching the blood and lymphatic stream, and 
transported thereby to the liver and various other 
organs, where it develops an echinococcus cyst. 
Once having reached its destination in the liver, it 
undergoes the following changes : The booklets 
disappear and the embryo is gradually converted 
into a small cyst, which presents two distinct lay- 
ers, an outer cuticular and an inner parenchyma- 
tous or granular-cellular layer, the whole being 
surounded bv a capsule of fibrous tissue. 

As the cyst develops there appears therein a 
clear limpid fluid, non-albuminous, and of low 
specific gravity (1009 to 1015). Hooklets are to 
be found in this fluid in a large majority of cases, 
and are of considerable diagnostic value. 

Such a cyst may increase in size without any 
alteration in its general structure. More com- 
monly, however, when the primary cyst has at- 
tained a certain size, buds develop from the inner 
parenchymatous layer, which are gradually con- 
verted into cysts which are identical in structure 
with the original cyst. These secondary or daugh- 
ter c\sts may project either inwardly or outwardly, 
and are soon set free from the mother cyst. In 
this way the parent cyst as it grows may contain 
a dozen or more daughter cysts. Inside of these 
daughter cysts a similar process may occur, and 
from the buds in the walls granddaughter cysts 
arc developed. 

Another form is the multilocular echinococcus 
cysts, in which the primary cyst buds develop and 
are then cut off completely and are surrounded by 
thick capsules of connective tissue, which join to- 
gether and ultimately form a hard mass repre- 
sented by strands of connective tissue, enclosing 
alveolar spaces about the size of peas. 

It is not known definitely how long the echino- 
coccus remains alive, probably many years, pos- 
siblv as long as 20 years. During all this time the 



THE HOSPITAL BULLETIN 



191 



c\st may continue to grow until it has reached 
an enormous size, without secondary changes. 
The most common change is death of the parasite 
and the gradual inspissation of the contents of the 
cyst, so that it becomes converted into a mass of 
l)utty-like material, which may be partially calci- 
fied. A more serious termination is rupture, which 
mav take place into a serous sac, or perforation 
may tal<e place into the bronchi, alimentary canal 
or urinary passages, when the contents of the cysts 
are discliarged externally. Most unfavorable are 
tlie instances of rupture into the superior vena 
cava. A third and very serious mode of termina- 
tion is suppuration, which may occur spontane- 
ou?l\- or following rupture. 

The symptoms of echinococcus cyst of the liver, 
in the absence of any of the complications referred 
to above, are entirely mechanical, and are due only 
to the pressure or weight of the tumor. Indeed, 
small c}sts may cause no disturbance. The larger 
cvsts are accompanied by feelings of pressure or 
dragging in the hepatic region, sometimes with 
actual pain. The general condition of the patient 
remains for a long time good, and the nutrition is 
little, if any, interfered with. The large and 
growing cysts produce signs of tumor of the liver, 
with a great increase in the size of the organ. The 
physical signs naturally depend much upon the 
situation of the growth, near the anterior surface 
in the epigastric region, the tumor may form a dis- 
tinct prominence and have a tense, firm feeling, 
sometimes with fluctuation. A rather common 
situation is to the left of the suspensory ligament, 
the resulting tumor causing upward displacement 
of the heart and an extensive area of dullness in 
the lower sternal and left hypochondriac regions. 
In the right lobe, if the tumor is on the posterior 
surface, the enlargement of the organ is chiefly 
upward into the pleura, and the vertical area of 
liver dullness in the posterior axillary line is in- 
creased. Superficial cysts may give the so-called 
"H\datid Tremilus." The tumor is palpated 
lightly with the fingers of the left hand, and per- 
cussed at the same time with those of the right, 
when there is felt a vibration or trembling move- 
ment which persists for a certain time. This is 
not, however, constantly present, and it is doubt- 
ful if it is characteristic of hydatid tumors, as was 
once supposed. 

When suppuration occurs the clinical picture is 
converted into one of rigors and sweats, with a 
greater or lesser amount of jaundice and rapid 



emaciation. I'erforation may occur into any of 
the parts mentioned, and in rare instances recovery 
has taken place. 

Treatment. — Although the existence of hyda- 
tids in the liver in the majority of cases is for a 
long time compatible with a fairly comfortable ex- 
istence, and many medical authorities advise non- 
interference when there are no distressing symp- 
toms, still the success of operative treatment has 
been so great that it is advisable, when hydatids 
have been diagnosed, to proceed at once to opera- 
tion. Simple aspiration was formerly extensively 
employed, and was successful in many cases, but 
more recent authorities state that by this method 
of treatment the mother cyst has not been re- 
moved, anfl that relapses frequently occur, even 
after apparent cure, and since operative measures 
have proved so safe, most modern surgeons do not 
hesitate to recommend them. The operation may 
be performed in either one or two stages. 

Operation in One Stage. — This is the more re- 
cently devised of the two operations, and has to a 
large extent supplanted the operation in two 
stages. All aseptic precautions having been taken, 
as in other abdominal operations, an incision is 
made over the most prominent part of the tumor 
down to the peritoneum. This is then carefully 
opened and the edges packed round with gauze. 
The tumor is incised, the contents evacuated and 
the edges of the cyst sewed to the abdominal 
wound, the gauze being withdrawn as the stitches 
are inserted. As suture material, either silk or cat- 
gut may be employed. A large drainage tube 
should be introduced into the cavity and the wound 
dressed aseptically. In cases where the cyst is 
covered by a considerable thickness of liver tissue, 
an aspirating needle should first be introduced to 
make sure of the character of the contents, the 
liver incised and a finger inserted through the 
opening to prevent hemorrhage, which can usuallv 
be controlled by sponge pressure. The edges of 
the opening in the liver should next be stitched to 
the abdominal wound, a large drain introduced 
into the cyst and sterile dressings applied. The 
stitches in the liver usually hold well. 

Operation in Tzi.'o Stages. — In this operation an 
incision is made along the lower margin oi the 
ribs over the cyst down to the peritoneum. All 
bleeding having been arrested, the peritoneum is 
incised the entire length of the wound and the 
wound then dressed with iodoform gauze. Ad- 
hesions form between the parietal peritr 1 e'.im and 



19- 



THE HOSPITAL BULLETIN 



that covering the tumor, which are usually quite 
firm in five or six days, when the tumor may be 
incised, the contents evacuated, the cavity irri- 
gated and a drainage tube introduced. This oper- 
ation has been verv successful, and is even yet pre- 
ferred by some surgeons. 

The following textbooks were employed in the 
compilation of this article: Stengel's Pathology, 
Keen's Surgery, Osier's Practice, .American Text- 
Book of Surgerv. 



HOOKWORM DISEASE IX ITS IXFEC- 

TIOX RELATIOX TO THE WHITE 

AXD COLORED RACE.* 



By Charles Fr.xxki.ix Strosxiohr, '\[. D.. 'oj. 



Vp to the present time very little work has been 
done in our Southern States in a given locality 
among both races which would give some idea of 
tile relative infection with hookworm disease, the 
reason therefor being concisely given in a reply to 
an inquiry bearing on the subject in question by 
Dr. J. Y. Porter. State Health Officer of Florida, 
who .says : "We have never seen any manifest 
evidence in the negro as in the white person, and 
have had all we can do looking after it where we 
could see it." 

I beg to invite your attention to the following 
data (see page 193). whicli has been collected 
from different sections of Xorth Carolina with a 
view to showing the percentage of negroes in- 
fected with hookworm disease as compared with 
the white race in the same school district of each 
county. 

Dr. C. L. Pridgen antl I have observed that 
where we have a rise in the infection among the 
whites we have a corresponding rise in the blacks, 
but always a much lower percentage. 

h'urthermore, I have observed that the infec- 
tion is higher among the mulattoes than among the 
full-blooded African, as was the case in the fol- 
lowing colored schools: Dudley, 67 per cent.; 
Shady Grove, 64 per cent. : Burgaw school. 55 per 



•Head iK'forp the Xiirth rainllna S(ali' Mi'diial ^^cn■iet.v, 
In I'liarlcittc. .\. C. .liinp 22, 19U. 



cent. The mulatto pupil- in these schools are in 
the majority. 

Suggestions bearing on the probable explana- 
tion for difference in percentage of infection : 

1st. Toughness of the African's skin on the 
bottom of his foot may play some part, even 
though the majority of the negro pupils whom I 
lectured to last school session gave a ground itch 
history. 

2d. Late rising in the morning". As a rule the 
negro youth does not rise early enough to be about 
during the time when the hookworm larvae are 
most active. 

3d. The negro youth's dislike for mud and 
water. After rains the negro youth usually re- 
mains indoors, for the reason that they do no like 
to be in the mud or water. The majority of the 
negro homes sit out in the open, with few if an_\-, 
shade trees near enough to serve the twofold pur- 
pose of relief and playgrounds. Therefore, the 
voung negro remains indoors until the sun has 
jjerformed the drying work, and the hookworm 
larvae, if any about, have sought protection be- 
neath the surface soil. 

4th. The general use of snuft' and tobacco. It 
is well known that the negro race is an extensive 
user of tobacco in one form or another. Chewing 
tobacco and dipping snuff' is begun in early youth. 
Tn either case frequent expectorations are neces- 
sarv. Therefore, should the hookworm larvae 
come up into the pharynx and mouth its chances 
for being swallowed would be few as compared 
with those of being expectorated. Again, much of 
the nicotine is picked up by the system and some 
of the tobacco saliva is swallowed, which may 
work some hardship on the parasite. 

5th. Pigment action. The pigment may have 
a repellant eft'ect upon the hookworm larvae. 

6tli. Secretion by the skin. In view of the fact 
that the negro race and hookworm disease are old 
in acquaintance, it may be that an anti-hookworm 
sulistance is secreted by the glands of the skin of 
the full-blooded African, which would either 
lessen the activity, act as a repellant or destroy the 
larvae. After finding such a large percentage of 
voung negroes giving a ground itch history and 
such a small percentage of the same pupils suffer- 
ing with hookworm disease, I am led to believe 
that either the ground itch in the majority of the 
cases is brought about by another factor or is due 



THE HOSPITAL BULLETIN 193 

to lidokwonn larvae, the same bcin^' killed at their 1 am indebted to Dr. U. W. Page, Distriet IJi- 

initial jioint of attack or by the use of tobacco, or rector of Sanitation, Salisljitry, X. C, for the fol- 

bv a cause as yet not mentioned. lowiii.L;- data from Rowan county: 

Hook- 

Kiiictiii Coiiiilv: No. R.xani. worm. Percent. 

,., , , ^. , ,' \ White. .31 7 22.5 

C icvolaiid scliool q^\ ,[ , (, , 

I am iiidel.tecl to Dr. C. L. Pridged, District Director of Sanitation, Marion, S. C, fnr tlie following data: 

Ashcvillc, Buncombe Couiitv: 

, , .„ ,. , , , ,,• , c I 1 (White. g,« 117 I-3-5 Sewered. 

.\sheville Graded and lligli Scliool q^^ . _ ,, , Sewered. 

Per cent. 

Bulk Ci>uiit\: Exam. Infect. Hookworm. 

,, /- , , , ,r I c , 1 (White. 328 161 49 Sewered. 

Morganton Graded and 1-ligli bchool i Col s7 Q 1'7 Sewered 

Oak Hill White. 13 6 47 R"ral. 

Willow Hill Col. 43 7 17 Rural. 

McDowell Couiilv: , ,,„ . „ ^ c i 

,,. ^ ,,,"., e . 1 White. 38 29 76 Sewered. 

Manon Graded and High School j ^^^1 ^, 22 31 Sewered. 

'I'he Irillow ing data has heen collected hy the writer : 

//"iiv"i' County, Brogdcn Totcnsliip: 

•,.,,, r- 11 1 u- 1 c 1 1 (White. 180 36 20 Sewered. 

Goldshoro Graded and H igh School ^ (,^^, ^^^g ■'g _^ _^ Sewered. 

-vt. /-.r /- J . 1 ij- 1 c 1 1 I White. 160 lor 63.1 Semi-rnral 

Mt.Olue Graded and High School ^ j^^, ^ ,, ^ Semi-rnral. 

,, ,, i White. 31 25 80.6 Rural 

""'"^y (Col. 57 38 67 Rural. 

Parker No. 2 White. 47 38 80.9 Rural. 

.\ugnsta No. 2 Col. 46 15 32.5 Rural. 

Thunder Swamp White. 39 21 53.8 Rural. 

Shady Grove Col. 25 16 64 Rural. 

Glenwood White. 20 20 100 Rnral. 

Davis Chapel Col. 19 7 36.8 Rural. 

c lit (White. ir3 62 S4.S Rural. 

.Seven rural schools ^ ^^y ^.^ ,_^ ,^8 j^^,^^, 

BrunswicI; Cmtnly: 

c .1 . <- J J e 1 r ( Wliite. 31 5 161 Semi-rural. 

Sonthport Graded School | ^^, g^ ^ ^ ^^ Semi-rnral. 

Pender County: 

P,.r,raw r,rn,^pA <i.rhr.r.] ^ Whitc. 157 HQ 75-7 Semi-rnral. 

I -urgaw Graded School j (^^, .^ ^8 55 Rnral. 

Nrzi- Hanover County: 

^^■ I 11 c 1 y White. 9 7 78 Rural. 

Middle Sound | (-^, ^^ /^ ^g^ j^^,^^, 

SEWERED ST.«iTISTlC.\L SUMM.\RY. 

White Pupils 1441 314 21.7 

Colored Pupils 738 ,^7 5 

NON-SEWERED ST.ATISTIC.L SUMM.\RY. 

White Pupils... 631 411 63.1 

Colored Pupils .*. 599 164 27.4 



Surgeon Rupert Blue, class of 1892, of the 
I'nited States Public Health and Marine Hos- 
pital Service, is being urged for appointment as 
head of that service, to fill the vacancy created 
by the death of Surgeon-General Walter Wynian. 

A few weeks ago Dr. Blue was sent to Hono- 
lulu to assist in stamping out a yellow fever epi- 
demic. He has been recalled to the L'nited States 
since the death of Dr. Wyman. 

Dr. Blue was born in North Carolina in 1S67 
After obtaining his diploma from the Universitv 
of Virginia he was graduated in medicine from 
the University of 2i[aryland in 1892. Immediate- 



ly after finishing his medical course he was ap- 
pointed to the Public Health and Marine Hosjjital 
Service, being promoted through the various 
grades to that of surgeon in 1909. 

He has specialized in the study of yellow fever 
and bubonic plague. His work in New Orleans, 
San Francisco, Honolulu, Quito and other places 
ranks with that of the army specialists in Cuba 
and Panama. He was a delegate to the Immigra- 
tion Medical Congress in Genoa in 1899. 

In San Francisco his remarkable success was 
attributed to his discovery that the plague is car- 
ried by ground squirrels as well as by rats. 



194 



THE HOSPITAL BULLETIN 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, December 15, 191 1. 



"MANY MICKLES MAKE A MUCKLE." 



L'nfortunately we have not been able to inter- 
est persons of large means, as yet, in the effort 
we are making to raise the $100,000 endowment 
fund for the Department of Pathology. We hope 
to have better success at some future time : in the 
meanwhile, however, we have not been idle, and 
though our efforts have not been rewarded as well 
as we might have desired, we are by no means dis- 
couraged. A number of circumstances have pre- 
vented our making as active a canvas as usual, 
and the sums contributed have been small. We 
are very grateful for these small contributions, 
for they usually mean a sacrifice on the part of 
the contributors, and we know that if we can get 
enough small contributions, the aggregate will be 
large. Remember the adage quoted above, and 
do not liesitate to contribute small sums if you are 
unable to give larger ones. The subscriptions to 
December i are as follows : 

Robinson bequest $5000 

Dr. Hugh Hampton Young, J. H. U 100 

Prof. R. Dorsey Coale, Ph.D 100 

Dr. S. J. Meltzer, LL.D., New York 10 

Dr. Gideon Timberlake 25 

Mr. H. P. Ohm 10 

Dr. .Samuel W. Moore, CD.S 25 

Dr. A. Sagebien, D.D.S., Cuba 5 

Thomas C. Basshor Company 10 

Hospital Bulletin 5 

Maryland Medical Journal 5 

Miss C. M. Selfe 5 

Mr. Geo. Lewis, Florida 50 

Mr. J. Henry Smith 25 

Islr. R. A. Krieger 5 

Hospital P>ulletin Co 5 

Summers Printing Co 15 



WilHanis & Wilkins Co 50 

Geo. W. Walther & Co 15 

Dr. John J. R. Krozer, 1848 50 

Dr. Eugene E. Cordell, 1868 10 

Dr. John G. Jay, 1871 25 

Dr. C. R. Winterson, 1871 10 

Dr. Joseph T. Smith, 1872 10 

Dr. W. J. Young, 1872 25 

Dr. Isaac S. Stone, 1872 10 

Dr. Thomas A. Ashby, 1873 100 

Dr. David W. Bulluck, 1873 100 

Dr. Robert Gerstell, 1873 5 

Dr. Randolph Winslow, 1873 100 

Jas. W. Humrichouse, 1873 25 

Dr. H. T. Harrison, 1874 5 

Dr. John D. Fiske, 1875 5 

Dr. Wilmer Erinton, 1876 100 

Dr. Wm. E. Wiegand, 1876 10 

Dr. Thos. Chew Worthingtoa, 1876 5 

Dr. R. H. P. Ellis, 1877 10 

L. Ridgely Wilson. 1880 5 

Dr. Charles W. Mitchell, 188 1 100 

Dr. L. Ernest Neale, 1881 100 

Dr. E. L. Meierhof, 1881 50 

Dr. J. M. Hundley, 1882 250 

Dr. Henry Chandlee, 1882 10 

Dr. Henry Chandlee, 1882 15 

Dr. B. Merrill Hopkinson, 1885 25 

Dr. J. C. Perry, 1885 100 

Dr. H. C. Reamer, 1885 10 

Dr. Frank Martin, 1886 lOO 

Dr. John R. Winslow, 1888 50 

Dr. C. W. McElfresh, 1889 100 

Dr. Saint Clair Spruill, 1890 100 

Dr. Rupert Blue, 1892 100 

Dr. Frank J. Kirby, 1892 50 

Dr. Walter C. Kirk, 1893 5 

Dr. Martin J. Cromwell, 1894 50 

Dr. Charles T. Harper, 1894 50 

Henry Lee Smith, 1894 10 

Dr. Harry Adler, 1895 100 

Dr. Jose L. Hirsh, 1895 50 

John McMullen, 1895 5 

Dr. Joseph W. Holland, 1896 50 

Dr. R. W. Sturgis, 1896 2 

Dr. Guy Steele, 1897 15 

Dr. Page Edmunds, 1898 50 

Dr. Albert J. Bossyns. 1898 5 

Dr. L. W. Armstrong-, 1900 10 

Dr. S. Demarco, 1900 50 

Dr. M. S. Pearre, 1900 5 

Dr. Irving J. Spear, 1900 50 



THE HOSPITAL BULLETIN 



195 



Dr. Win. Tarun, 1900 50 

John Honff, 1900 25 

Win. H. Smith, 1900 25 

Dr. J. D. Reeder, 1901 50 

Dr. Nathan Winslow, 1901 50 

Dr. \\' m. R. Rogers, 1901 25 

Dr. Arthur M. Shipley, 1902 250 

Dr. H. C. Davis, 1902 10 

Dr. H. L. Rudolf, 1902 25 

Dr. Hugh Brent, 1903 25 

Dr. G. C. Lockard, 1903 25 

Dr. Geo. S. M. Kieffer, 1903 25 

Dr. H. J. Maldeis, 1903 25 

Dr. Howard J. Iglehart, 1903 25 

Howard W. Jones, 1903. 25 

Fred L. Wilkins, 1903 25 

Albert L. Wilkinson, 1903 25 

Dr. R. C. Metzel, 1904 10 

Dr. Ejnar Hansen, 1904 10 

Chas. Bagley, Jr., 1904 25 

Alvin B. Lennan, 1904 25 

M. A. Weinberg, 1904 25 

Herbert E. Zepp, 1904 25 

Dr. Robert P. Bay, 1905 100 

Dr. B. F. Tefft, 1905 100 

Dr. Jos. A. Devlin, 1906 10 

Dr. W. F. Sowers, 1906 25 

Dr. Robt. W. Crawford, 1906 25 

Dr. Leo Karlinsky, 1906 20 

Dr. J. F. Hawkins, 1906 25 

Richard C Hume, 1906 10 

Dr. Frank S. Lynn, 1907 25 

Dr. T. H. Legg, 1907 5 

Dr. Albert H. Carroll, 1907 25 

Dr. Edgar S. Perkins, 1907 25 

W. Cuthbert Lyon. 1907 5 

Thomas H. Phillips. 1908 25 

Dr. J. N. Osburn, 1909 5 

Dr. E. H. Kloman, 1910 25 

'I'crra Mariae. 191 i 3- SO 

Total $9030 . 50 

•Additions for month, $328.50. 



ABSTRACT 



Dr. John Rawson Pennington, class of 1887, of 
4613 Winthrop avenue, Chicago, 111., in a paper 
upon "Cancer of the Rectum," read before the 
last meeting of the American Proctological .So- 
ciety, writes : 

"I take it we are all agreed as to the increasing 



frequency of cancer. At least it seems to me no 
other conclusion can be drawn from the following 
figures : According to the twelfth U. S. census 
cancer appears to have increased 12.1 deaths per 
100,000 population in the previous decade. In 
(Ireat Britain, so we learn from the work of 
Roger Williams, the deaths from cancer increased 
from 177 per million in 1840 to 885 per million 
living in 1905. Williams points out that while 
the population barely iloubled from 1850 to 1903, 
tlie mortality from cancer increased more than 
sixfold. Nor is the increase confined to the 
I'nited States and Europe ; it holds good for 
Ja])an, India, and even for uncivilized countries. 
In short, cancer is one of the several diseases 
which is apparentl}' increasing by leaps and 
bounds, in spite of our boasted progress in medi- 
cine, surgery and hygiene. Apart from the in- 
creased prevalence, the present death rate from 
malignant diseases is something dreadful to con- 
template. Our anxiety in regard to malignant 
disease of the rectum is pardonable when we re- 
llect that a good proportion of cancers involve this 
region. Williams found that 9.6 per cent, in 
males and 5.3 per cent, in females were located in 
the rectum. Is there anything that can be done 
to check this foe? The writer believes there is, 
and that this society may be made a powerful fac- 
tor for good in such a crusade. In Germany a 
similar crusade has been started against cancer 
of the uterus by Winters, agitating the subject 
both among the profession and the laity. It is 
estimated that the number of cases of inoperable 
cancer of this organ has been reduced over 30 
per cent, as a result of calling attention to the 
early symptoms. Of the 2914 cases of rectal can- 
cer in the male referred to by Williams, 2592 pa- 
tients were over 45 years of age and 2180 of the 
-53?i female patients In the male sex, again, the 
average age at which the onset was noted was 
-19-7 years, the minimum being 1O.75 and the 
maximum 74, while in the female se.x the average 
was 50.4 years, with a minimum of 21. 8 and a 
maximum of 88 years. This brings me to the 
crux of my argument, that every person who has 
reached the so-called 'cancerous age" should be 
examined periodically for evidence of commenc- 
ing carcinoma, not necessarily of the rectum 
alone, but in the female, for example, of the 
uterus also. 

"In 120 resections of the rectum for malignant 
disease W. J. JMayo observes: "It is an unfortu- 



196 



THE HOSPITAL BULLETIN 



nate fact that in the majority cancer of the rec- 
tum is not recognized in time to obtain a radical 
cure.' I said a moment aijo that cancer in the 
beginning" is a local disease. This granted, then 
early and thorough removal must lead to a cure. 
It has been shown that a large proportion of ma- 
lignant growths originate in scar tissue. In can- 
cer of the stomach, for example, the Mayos found 
that no less than 62 per cent, showed evidences of 
a previous ulcer. In rectal cancer patients fre- 
quently give a history of previous operations on 
the part. Does the cancer occur in the scar left 
from an operation for hemorrhoids done by one 
of the commoner methods, ligature, clamp and 
cautery, or some other technic leaving much scar 
tissue and sometimes stricture? May it not be 
occasionally engrafted on the scar following the 
usual incision method of operating for fistula ? 
Here is a suggestion for us in our own work : 
Secure smooth healing by resorting only to such 
procedures as leave the minimum of cicatricial 
tissue, hence the least possible nidus for possible 
mischief in the future. With the co-operation of 
the pulilic it seems to me we should learn much 
about cancer in the early stages. To educate the 
public we must, as has been well said, 'organize, 
.systematize, deputize, energize, supervise and 
economize,' The field is broad and the oppor- 
tunity is at hand. Shall we grasp it?" 



ITEMS 



Dr. Henry Wheeler McComas, class of 1888, 
of Oakland, Aid., in a recent interview in the Bal- 
timore Sun, deplores the entrance of the physi- 
cian into the political field, feeling that "it is true, 
unfortunately, that in almost every county physi- 
cians are either candidates for high offices, which 
take up a large share of their time, or are re- 
garded by the party workers as the principal vote- 
getters on their lists. 

"I have been mayor of Oakland several terms, 
but I shall never again be a candidate, for the 
reason that I do not conceive it to be right for 
physicians to mix in affairs of government, how- 
ever simple. 

"The practitioner of medicine should keep out 
of ])olitics, just as carefully as members of that 
higher ])rofession who w'ear the 'cloth.' 

"Physicians ])laying politics can not find the 
time necessary for the proper care of their pa- 
tients. Thev reach a state of stagnation. It is 



well known, too, that the physician who does not 
read and keep abreast of the thought of his time 
cannot do justice to his clientele, or make any 
progress that is worth while." 

Dr. Henry W. McComas is a son of Dr. Josiah 
Lee AlcComas, a member of the class of 1858, 
and now 87 years of age. Dr. Henry AlcComas 
has been practicinig for over 27 years in ^^'estern 
Alaryland, and for many years conducted the first 
hospital in Garret county. He possesses the 
unique distinction of having four sons studving 
medicine, and three daughters in training as 
nurses. 



Callender F. Winslow, son of Prof. Randolph 
Winslow, who was recently operated upon at the 
University Hospital for appendicitis, has suffi- 
cientlv recovered to return to his home. 



Dr. Clifton Norwood De \'ilbiss, class of iQio, 
assistant resident surgeon in the University Hos- 
pital, is a patient there. 



Dr. Norman Thomas Kirk, class of Hyio, of 
Rocky Mount, N. C, was a recent visitor to the 
I'niversity Hospital. 



The Phi Sigma Kap])a fraternity has removed 
from 1004 McCulloh street to 816 Park avenue. 
The\' held their housewarming on the evening of 
November 17, 191 1. 



Colonel Louis Mervin Maus, M. D., class of 
1874, surgeon United States Army, has written 
a book, "An Army Officer on Leave in Japan," 
wdiich has been published by .\. C. McCIurg Com- 
pany, 191 1. The book is most favorably reviewed 
in the Military Surgeon for December, 191 1. We 
wish Colonel Maus much success with thi.s work. 
In it he appears as a Mr. Rhodes, who holds an 
important position in the National Bureau of 
Commerce, and who hurriedly tours the Orient. 
He visits Manila, thence to Japan via the usual 
Army route, landing at Nagasaki, and traveling 
as far north as Nikko. Cha])ters are introduced 
on the religion, customs, the recent war with Rus- 
sia, the origin and history of the Japanese people, 
also notes on hotels, guides, ricbshas and rail- 



THE HOSPITAL BULLETIN 



197 



roads. The book is a valuable sviidebook to 
jajian, and highly interestiiT^-. W'c wish that the 
author would send a copy to the L'ni\-ersity Li- 
l)rary. Alto.^etiicr, the record of the I'niversity 
of .Maryland men in the I'nited States service is 
rather enviable. 



.At the last nieetini^- of the I'niversity of Alary- 
land Aledical Society, held in the hosjiital ani- 
lihitheatre Tucsdax', November 21, 1911, Dr. Rob- 
ert I'arke Hay. class of Hp5. was elected presi- 
dent for the ensuing year; Dr. C. W. AIcElfresh, 
class of 1889, vice president, and Dr. .Arthur 
Louis Fehsenfeld, class of 1009, secretary. 



W'e are anxious to secure three copies of the 
-April. 191 1, BuLiJCTix, containing Dr. John C. 
Hemmeter's article on "Henry R. Carter — .A 
Pathfinder in the Etiology and Prophylaxis of 
A'cUow Fever." and will thank any of our readers 
who can sujiply us with this issue. 



Dr. llenr\- .A. Naylor. class of 1900, of Pikes- 
ville, .Aid., wliii was recently operated upon at the 
L'niversitv 1 lospital for apjicndicitis. is rapidly 
recovering. 



Dr. \\illiam E. E. Tyson, class of 1905, is anx- 
ious to know if Dr. Alitchell still remembers his 
full name. Dr. Tyson has built up a splendid 
practice in Detroit. 



\\"e regret to atmounce that our good friend. 
Dr. Eugene Fauntleroy Cordell, has been ill re- 
cently, and are glad that we can state that he is 
now convalescent. 



Among the recent visitors to the L'niversitv 
llosjiital were Drs. Norman Heggie. class of 
TOOJ, of Jacksonville, Ela., now fully recovered 
from his recent attack of typhoid fever: Louis 
Hamilton Seth, class of 1908, of AIcDaniels. Aid. ; 
Walter P.. Kirk, class of 1893, of Darlington, Aid., 
wlio-^e wife was for a time quite ill at the Hos- 
pital, but who is now sufificiently recovered to 
return to her home ; Daniel Alvery Watkins, class 
of 1903, of Hagerstown. Md., and James Lee 
Hopkins, class of 1897, of Havre de (".race. Aid. 



Dr. George A'elkjt Ala-^.^enburg, class of 191 1, 
who was ill with typhoid fever, has recovered suf- 
ficiently to return to his duties at the Church 
1 liinie and Infirmar\". 



Dr. .Albert Hyson Carroll, class of 1907, is now 
located at 906 .\. Calvert street. 



Dr. Eugene Bascom Wright, class of 1909, was 
recently appointed superintendent of the Church 
Home and Infirmary, vice Dr. Don Preston 
Peters, resigned. Dr. Wright was formerly as- 
sistant superintendent at the same hospital. \\'e 
wish him the highest success in his work. 



Dr. Lester J. Efrid, class of 1903. in partner- 
ship with Drs. J. B. S. Holmes and R. AI. Goss, 
announces the opening of "The Flalcyon," a pri- 
vate sanatorium for surgical, gynecological, ob- 
stetrical and medical cases, at Tampa Bay Hotel 
Park, Tampa, I'la., and invites the physicians of 
the countrv to visit him there. 



Dr. G. Timberlake, clinical professor of genito- 
urinary diseases, has been elected an honorar}' 
member of the Kanawha Aledical Society of W'est 
\'irginia. 



Dr. J. B. Edwards, class of 1911, has removed 
from Wedgefield, S. C, to Saluda, S. C. 



Dr. Edward .Anderson, class of 1875, of Rock- 
\ille. Aid., has been reappointed jihysician to the 
almshouse of Alontgomerv countv. Alarvland. 



The annual banquet of the General .Alunuii .As- 
sociation of the L'niversity of Afaryland was held 
at the Rennert Hotel on the evening of .Academic 
Day, November 13, 1911, at 8 P. AI. The alumni 
were addressed by Prof. C. .Vlphonso Smith, 
Edgar .\llan Poe Professor of the University of 
A'irginia and Roosevelt Exchange Professor with 
the University of Berlin, and Messrs. J. Walter 
Lord and T. Scott OfFutt of the Baltimore and 



198 



THE HOSPITAL BULLETIN 



Towson bar, and by ^Ir. Carl Schon, entertainer. 
Governor Crothers and Alayor Preston had ac- 
cepted invitations, but were unable to be present. 

Professor Smith's address on American Litera- 
ture was a masterpiece of after-dinner speaking. 
It was instructive and well worth a place in the 
lectures of a college, yet at all times brilliant and 
entertaining. His audience regretted when he 
ceased speaking, and we feel that the privilege of 
hearing his address was well worth the labor con- 
nected with the arrangement of the banquet. 

The banquet committee were i\Ir. Frank V. 
Rhodes, chairman ; Drs. B. ]\Ierrill Hopkinson, 
Nathan ^^'inslow, and Messrs. John Henry Skeen 
and Henry P. Hynson. 

The medical alumni present were Drs. Comp- 
ton Riely, H. J. ]\Ialdeis, W. F. Sowers. Joseph 
E. Gichner. John C. Hemmeter, T. O. Heatwole. 
A. L. Wilkinson, H. M. Robinson, Irving J. 
Spear, Robert P. Bay, Howard W. Jones, H. C. 
Davis, John C. Uhler, J. T. O'.AIara, A. H. Car- 
roll, C. R. Winterson, J. W. Holland, B. M. Hop- 
kinson, Arthur AI. Shipley. A. L. Fehsenfeld, R. 
L. Mitchell, F. H. Vinup, I. H. Davis, S. De- 
marco, G. S. M. Kieffer, E. H. Kloman, Charles 
E. Sadtler, Hugh Brent, Eugene F. Cordell, J. D. 
Igleliart, J. M. Hundley, Samuel T. Earle, ^\'. H. 
Smith, Xathan Winslow, Randolph Winslow and 
W. G. Clopton. 



hill, 1865, were elected to fill the vacancies of the 
Medical Department in the Alumni Council. 



Dr. William V. Parramore, class of 1910, has 
been elected superintendent of the Georgia Tu- 
berculosis Sanatorium at Alto, Ga. 



Dr. John C. Hemmeter has sold his residence at 
1735 Linden avenue to Dr. Charles E. Simon. 



Dr. ^Maurice E. B. Owens, class of 1910, is lo- 
cated at Long Lake, Washington. 



Dr. \\alter S. Niblett, class of 191 1. has been 
appointed assistant resident physician to the 
James Lawrence Kernan Hospital and Industrial 
Home for Crippled Children. Dr. \\'illiam Henry 
Daniels, class of 1907, has been reappointed head 
of the dispensary at 2000 North Charles street. 



Dr. William Joseph Durkin, class of 191 1, is 
an assistant resident surgeon in Kings County 
Hospital, Brooklyn, N. Y. 



At the annual business meeting of the General 
Alumni Association of the University of Mary- 
land, held on November 13, at 7 P. M., in the 
Hotel Rennert, just prior to the annual banquet, 
the following officers were elected for the ensuing 
year : 

President, Dr. Charles E. Sadtler, class of 
1S73: vice-president, Mr. James W. Bowers of 
the Law Department : recording secretary, Mr. 
John Henry Skeen of the Law Department; cor- 
responding secretary. Dr. Nathan Winslow, class 
of 1901 : treasurer, Mr. Eugene Hodson of the 
Pharmacal Department ; board of directors, 
Messrs. Dawkins and Revell, St. Johns ; Drs. 
.Adler ( T895) and Earle (1870), Medical; 
Messrs. Rhodes and Mackenzie, Law : Drs. Gor- 
gas and Geiser, Dental, and ]\Iessrs. J. B. Thomas 
and Hengst, Pharmacy. 

Drs. Joseph E. Gichner, class of 1890; Robert 
L. Mitchell, class of 1905, and G. Lane Taney- 



Dr. Henry ]j. Athey, class of 191 1, is located 
in Newark, N. J., where he is doing post-graduate 
hospital work. 



Dr. Harry B. Gantt, class of 1880, of Millers- 
ville, Anne Arundel county, Md., is ill at the 
University Hospital suffering with septicemia. 
His son, Dr. H. B. Gantt, Jr., class of 1909. also 
of Millersville, is attending to his father's prac- 
tice durina; his illness. 



Dr. Joseph E Gichner, class of 1890, is con- 
ducting a German clinic at the University Hos- 
pital. He cordially extends an invitation to all 
interested to attend. As far as we know, this is 
the only clinic in Baltimore conducted in German, 
and it therefore affords an excellent opportunity 
to those desiring to familiarize themselves with 
German as employed in medicine. 



THE HOSPITAL BULLETIN 



199 



Dr. Oliver Arnold llmvanl, class of 1906, of 
^L-irlinton, \V. V'a., was a recent visitor to the 
University Hospital. 



Dr. juhu tiuirley .Missildine, class of 191 1, of 
Wichita, Kans.. was a recent visitor in Baltimore. 
We are glad to report that he was tied for third 
position in the Nehraska State Board medical 
examinations, and received the highest mark 
liivcn in surgery. 



Dr. To.seph McElhattan, class of 1906, is lo- 
cated at Freeport, Ohio, where he has succeeded 
in building up a lucrative practice. 



Miss Mary Louise Gephardt, of University 
Hospital Training School for Nurses, class of 
191 1, is a patient at the University Hospital. 



Dr. John R. Winslow, clinical professor of 
diseases of the nose and throat, was recently con- 
Hned to his home with grip, but has sufficiently 
recovered to resume his duties. He will remove 
his offices from 114 West Franklin street to the 
Latrobe Apartments, Charles and Read streets, 
immediately upon their completion. 



Dr. Randolph Winslow, class of 1883, and Dr. 
J. Mason Hundley, class of 1882, attended the 
meeting of the Southern Surgical and Gyneco- 
logical Association, held in W'ashington Decem- 
ber 12 to 14, before which meeting Dr. Winslow 
])resented a paper. 



The L'niversity of Maryland alunmi are well 
represented in the list of the State's health of- 
ficers. The following alumni are secretaries of 
the Board of Health in their respective counties : 

Anne Arundel county. Dr. Walton Hopkins, 
class of 1904, Annapolis. 

Baltimore county. Dr. James F. H. Gorsuch, 
class of 1876, Fork. 

Caroline county. Dr. Frederick N. Nichols, 
class of 1902, Denton. 



Carroll county. Dr. Charles Ryle Foutz, class 
of 1897, Westminster. 

Charles county. Dr. Francis E. Jamison, class 
of igo7, Newport. 

Dorchester county, Dr. X'ictor Calvert Carroll, 
class of 1906, Cambridge. 

Garrett county, Dr. Henry Wheeler McComas, 
class of 188S, Oakland. 

Harford county, Dr. Walter B. Kirk, class of 
1893, Darlington. 

Queen Anne's county. Dr. Arthur E. Landers, 
class of 1907, Crumpton. 

Talbot county. Dr. Edward Richard Trippe, 
class of 1862, Easton. 

Washington county, Dr. Jephtha Ellsworth 
Pitsnogle, class of 1889, Hagerstown. 

Wicomico county. Dr. Charles R. Truitt, class 
of 1 891, Salisbury. 

In addition to the above secretaries of county 
boards of health, the University is represented by 
the following alumni as secretary of town boards 
of health : 

Brooklyn, Anne Arundel county, Dr. Charles 
H. Brooke, class of 1891. 

Cambridge, Dorchester county, Dr. Eldridge 
Eakin WoliY, class of 1899. 

Brunswick, Frederick count}-. Dr. Levin West, 
class of 1886. 

Aberdeen, Harford county. Dr. Charles Henry 
Kriete, class of 1895. 

Kensington, Montgomery county. Dr. William 
Latane Lewis, class of 1892. 

Laurel, Prince George's county. Dr. William 
Franklin Taylor, class of 1884. 

Crisfield, Somerset county, Dr. Clarence E. 
Rogers, class of 1902. 

Easton, Talbot county, Dr. Philip Lee Travers, 
class of 1902. 



Dr. Herbert E. Zepp, class of 1904, is located 
at Rosedale street and North avenue, Baltimore. 



BIRTHS 

November 11, 191 1, Franklin Clapp Tyson, son 
of Dr. William E. E. Tyson, class of 1905, of 2609 
JefTerson avenue. East, Detroit, Mich. 



200 



THE HOSPITAL BULLETIN 



ENGAGEMENTS 

^Tr. and Airs. Roger W. Cull have announced 
the engagement of their daughter, Sarah White, 
to Dr. Richard Caldwell Hume, class of i9o5, of 
Brookmeal, \'irginia. The wedding will take 
place during this Decemher. 



Mr. and Mrs. L. Feitelherg, of 1635 N. Frank- 
lin street, Philadelphia, Pa., have announced the 
engagement of their daughter, Ida, to Dr. Henry 
Lyon Sinskey, class of 1908, of 1610 East Balti- 
more street, Baltimore, Aid. The wedding will 
take place early in the winter. 



of the groom: Harry Baetjer, cousin of the 
groom, and Drs. William Royal Stokes, class of 
1891, and George Dobbin, class of igo.^. 

The bride, who was unattended, wore a travel- 
ing suit of Copenhagen blue and a large picture 
hat ornamented with plumes, and carried a show-er 
bouquet of orchids and violets. After the cere- 
mony a wedding breakfast was served at the 
residence of the bride's sister, Mrs. George W. 
Dobbin, 56 W. Biddle street. Mr. and }ilrs. Kop- 
pelman left for a Canadian tour, and upon their 
return will reside at Tudor Plall Apartments, Bal- 
timore. 



MARRIAGES 

Dr. Ernest Harrison Rowe. class of 1906, and 
Aliss Nina Grace Horner, daughter of Mr. and 
Mrs. George Allen Horner, were married Xo- 
vember 23, 191 1, at the residence of the bride's 
parents, 201 Goodwood Gardens, Roland Park, by 
Rev. Dr. Robert M. Greene of Philadelphia, and 
Rev. W. L. McDowell of Baltimore. 

The bride was attired in white satin, trimmed 
with old lace worn by both her mother and grand- 
mother upon the occasion of their weddings. She 
wore a tulle veil caught up by orange blossoms 
and carried lilies of the valley and white orchids. 
Miss Marion Cameron was maid of honor. Dr. 
Herbert Schoenrich, class of 1907, was best man. 
The couple left upon a Northern trip and upon 
their return will resifle at the Homewood Apart- 
ments, Baltimore, Md. 



Dr. Harry Ralph .Seelinger, class of 1910, of 
Norfolk, \'a.. was married on Tuesday, Novem- 
ber 28, 191 1, to Miss Mary I iamilton Mason, also 
of Norfolk. 



Miss Grace Lawrence Dunderdale, L'niversity 
Llospital Training School for Nurses, daughter 
of Mr. and Mrs. Cleaveland Dunderdale of New 
York, was married to ]\lr. Walter Koppelman of 
Baltimore at iMuanuel Protestant Episcopal 
Church on Wednesday, November 29, 1911, at 
noon. The ceremony was ])erformed by Rev. 
Dr. 1 lenry E. Cotton. The best man was .Mr. 
.Arthur Koppelman. brother of the groom, and the 
ushers were Messrs. William Koppelman, brother 



DEATHS 

Dr. Pierre George Dausch, class of 1S68, died 
suddenly at his home, Alonument and Dallas 
street, Sunday, November 26, 1911, of heart dis- 
ease, aged 65 years. Dr. Dausch was dining when 
stricken, and fell to the floor. He was placed in 
his bed and medical helj) summoned, but he onlv 
lived a few hours. 

Dr. Dausch was a native of lialtimore. born 
April 30, 1850, the son of Anthony Dausch. He 
was educated at Loyola College, receiving the de- 
gree of A. B. and later A. M. from that institu- 
tion. He was a member of the faculty of the 
College of Physicians and Surgeons in 1870, and 
at the same time editor of The Physician and 
Surgeon. He lived for a number of years at 121 
Jackson Place, and was well known in East Bal- 
timore. He is survived by his wife and three sons. 



Dr. \\'illiam F. Hengst, class of 1876, died at 
his home, 21 3 1 N. Calvert street, Baltimore, on 
December 4, 191 1. after a year's illness. Dr. 
Hengst was a son of the late Rev. Benjamin 
Hengst, a minister in the German Evangelical 
Church, and was a native of Baltimore. He is 
survived by his wife, Mrs. Martha Hengst. He 
was 58 years of age. Interment was in Lou<lon 
Park Cemetery, December 6, 191 1. 



Dr. Harrx- ^'ictor Harbaugh, class of 1907, of 
iv-ist New Market, Md., died November 10, 191 1, 

in the Caniljriilge llnspital, Cambridge. Mtl., of 
iHicumonia, asjed 28 \ears. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
I'MCE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-oincc 
. as Second Class Matter 



Vol. VII 



BALTIMORE, MD., JANUARY IS, 1912. 



No. 11 



SEE AMERICA FIRST. 



Bv RaXDOLPH \\'Ii\SL(1\V. 



5. THE VKLI.O\\'ST0XE NATIONAL PARK. 

From Salt Lake City to the Yellowstone is a 
iiiLrht's journey on the (3regon Short Line. This 
railroad lands its passengers at the western en- 
trance to the Park, where they take stages for 
the tour of the Park, which can be accomplished 
in five days. The area of the reservation is 55 by 
65 miles, and the greater portion of it lies in the 
northwest corner of the State of Wyoming, with 
narrow strijjs from the adjoining States of Idaho 
and Montana. The Park is in the heart of the 
Rock}' Mountains, and is at an elevation of from 
6ooo feet in its valle\-s to 8300 at the Continental 
Divide, while many of its mountain peaks rise to 
an altitude of from 10,000 to 11,000 feet. There 
is probably no area of similar size in the whole 
world that presents so many and so varied objects 
of exceptional interest as are here grouped close 
together. Doubtless the whole reservation is re- 
plete with interest, but only a limited portion near 
its center is embraced in the official tours. 

We reached Yellowstone Station at 7 o'clock on 
the morning of July 11, and. after breakfasting, 
secured a M.-Y. coach with seats for 1 1 passen- 
gers, in which v.e made the entire circuit. A few- 
days previously a heavy snowstorm had occurred, 
but during our visit the weather was usually warm 
in the day time, but became cool at night. Mos- 
quitoes were out in full force and attacked with 
great ferocity, but usually retired about 9 P. M. 
and allowed the discomfited traveler to rest in 
peace. The first stage of the trip was from the 
railroad to the Fountain Hotel, a distance of 19 
miles. Starting at Christmas Tree Park, so called 
on account of the grove of straight pines through 



which the road runs, we follow the valle_\' and 
canyon of the ?\IafIison River to the confluence 
of the Gibbon and Firehole rivers, and thence 
along the latter stream to the Lower Geyser Ba- 
sin. This portion of the Park is attractive, but 
does not exhibit any features of great scenic 
beauty or of remarkable interest. One thing, 
however, is noticeable, not only here, but all over 
the Park, and that is the enormous destruction of 
timber that has occurred at some time, probably 
cpiite remote, as the fallen as well as standing 
dead trees are bleached to an almost sepulchral 
whiteness. At the Fountain Hotel one gets a sub- 
stantial luncheon and then immediately inspects 
the geysers and hot springs of this lower geyser 
basin. At least he inspects some oi th^m, for the 
basin covers an area of 35 to 40 square miles, and 
('193 hot springs and 17 geysers have been officially 
catalogued in this region. The springs contain 
hot or boiling water which flows continuously, 
while the geysers are springs that empty into 
heated caverns until a sufficient quantity of steam 
has been generated to cause an eruption of the 
\\ater and steam, often occurring at stated inter- 
vals, but sometimes irregularly. The water is 
projected violentlv upwards, in some instances to 
a height of 250 feet, emitting not only steam and 
water, but in many cases a thundering noise that 
can be heard at a long distance. In Iceland and 
Xew Zealand geysers are found, but the}' are few 
in nuniber, while in the Yellowstone Park 70 are 
found in a limited area, and more than 2000 hot 
springs. The boilirig water holds salts in solution, 
and as it flows over the surface deposition of these 
chemicals takes place, forming mounds or en- 
crustations which in man}- instances are very thin 
and through which the unwary are liable to break 
and to meet an untimely end. It is related that a 
woman, in a spirit of bravado, approached too 
close to the edge of a spring, broke through the 



202 



THE HOSPITAL BULLETIN 



formation and disappeared from view forever. In 
dangerous places soldiers are ])Osted to warn peo- 
ple not to approach too closely. The Fountain 
and Great Fountain geysers are the chief attrac- 
tions at this point, l)ut their intervals of erujition 
are so prolonged that the transient tourist stands 
but a slight chance of viewing them in action. 
Many hot springs fire found here, from which 
steaming water constantly flows and which are 
often of great beauty. One of the most interest- 
ing of the natural phenomena to be observed here 
is the Mammoth Paint Pots. This is a depression, 
with raised edges, 40x60 feet in area, in which 
white and drab colored mud is in a constant state 
of ebullition. The mud is raised up to a limited 
distance, and there is a constant succession of 



ever\- (13 to 70 minutes, day and night, gives its 
Ijeautiful exhibition. The Morning Glory Spring 
is a silent pool of hot water which in shape and 
coloring resembles a beautiful blue morning glory. 
The Punch Bowl and Emerald springs are fasci- 
nating pools, while the Handkerchief Pool is a 
source of amusement to those who drop their 
handkerchiefs into it. The handkerchief disap- 
pears from view, but in a few minutes it is re- 
turned to }ou laundered. Tlie writer found it 
both entertaining and useful, as his supply of 
handkerchiefs had gotten down to one, and that 
one very soiled. After a few ablutions m the 
spring it was returned to him washed and ready 
for use. .\ lady who thought she would try an- 
other spring, dropped her mouchoir in ; it disap- 




OLU I AiTiirrr, i.nn. Yellowstone park. 



plop-plop noises as bubbling up takes place in dif- 
ferent parts of the mud caldron. Several miles 
distant is the Midway Geyser Basin, where there 
is another collection of springs and geysers. The 
Turquoise Spring, so called from its beautiful 
blue color, and the Prismatic Lake, which is a 
large bowl filled with water showing a great va- 
riety of hues ; the Sapphire Pool, Black Pearl and 
many other pools are found here. Nine miles 
from the Lower Geyser Basin, on a somewhat 
more elevated plateau, is the L'pper Geyser BasiiL 
Time and words fail in which to describe this 
wonderful basin. Great geysers spout almost 
continuously within the field of vision, such as the 
Giant, which projects a column of boiling water 
250 feet into the air; the (Irand, Splendid. Bee- 
hive and Old Faithful. The latter is the most 
interesting, as it is situated close to the hotel, ;mil 



peared from view and she never saw it again. 
Old Faithful Inn is a beautiful, commodious and 
up-to-date hotel, built of logs, with the stairways 
constructed of split logs. Its central portion rises 
to the height of eight stories, though it is open 
to the roof. Our first day's journey of 20 miles 
terminated here, and after a good night"s rest we 
were up betimes and ready for travel before S 
o'clock. Our route was mostly through forests 
and over the Continental Divide to Thumb Lunch 
Station, on the Yellov.'stone Lake, 19 miles dis- 
tant. On the summit of the Continental Divide 
is a small lake, known as Two Ocean P'ond, the 
waters of which flow from two outlets, one into 
the Atlantic through the Yellowstone, Missouri 
and ^lississippi rivers, the other into the Pacific 
through the Snake River, an affluent of tl'.e Co- 
lumbia. We get our first view of Yellowstone 



THE HOSPITAL BULLETIN 



203 



Lake as \vc approach Thumb Staliun. Tliis lake 
is itself both beautiful and wonderful, it is about 
15 b\- 23 miles in area and of great depth. It is 
the largest body ui water at its altitude in the 
world, except Lake Titicaca in Peru. The water 
is mostly derived from the melting of the snow 
mantle of the surrounding mountain ranges, and 
is cold and pure. It is supposed that the seepage 
of water, through fissures at the bottom of the 
lake, into caverns in. \\'hich the rocks are still 
heated from subterranean fires, is responsible for 
the great number of geysers found in the Park. 
There are a number of ge}sers, hot springs and 
paint pots found at Thumb Station, but none of 
great interest except the Fishing Cone. This is 
a mound with a boiling spring in its center, situ- 



from the hotel. As night approaches large num- 
bers of wild bears flock to the feeding groimds 
and .gorge themselves with the garbage that is 
thrown out for their lienefil. If unmolested, they 
are rarely dangerous, though they have been 
known to attack human beings, unprovoked. 
Likewise they do not usualh' molest othev ani- 
mals, but during otir visit a bear killed a fawn 
after a fight with its mother. The view from the 
Lake Hotel is lieautiful: the waters of the lake, 
either Hashing in the sunshine or shimmering in 
the moonlight, are equally attractive, while the 
snow-capped mountains in the distance form a 
suitable setting for the scene. 

The third day's journey is from the lake -o the 
Grand Canyon, a distance of !<) miles. This is a 




.M.\MMOTII HOT Sl'l;IN(;.s. yi:li.iiw.sto.\k r.MiK. 



ated on the shore of the lake, upon which fisher- 
men stand, and after catching the fish can turn 
around and boil it in the spring while still on the 
hook. At this point one can take an e'.ectric 
launch and travel comfortably to the other end of 
the lake for $2.50, or he can resume his journey 
by coach, and after an exceedingly dusty drive, 
during which we were almost devoured by mos- 
quitoes, he reaches the Lake Hotel at the outlet 
of the lake, 16 miles distant. There is but little 
of interest to be seen on this drive and much dis- 
comfort to be experienced; hence one will do 
well to take the boat instead. The river at the 
outlet is teeming with fish, and parties enjoy ex- 
cellent fishing here. The hotel is a large colonial- 
looking building where guests frequently make 
prolonged visits. One of the interesting sights 
here is the feeding of the bears on the refuse 



pleasant drive through a parklike country called 
Hayden's \'alley, in which herds of elk and other 
animals are usually seen, as well as flocks of 
geese, swans and ducks feeding in the river and 
pools in this portion of the Park. ^lud geysers 
are also seen on this drive that are in a constant 
state of activity, and from which vapors of sul- 
phuretted hydrogen are constantly escaping. As 
we approach the canyon the river becomes rapid 
and tumultuous, and then dashes over a perpen- 
dicular cliff 112 feet, constituting the Upper Falls. 
Continuing its riotous way, the rapids again make 
a sudden drop of 360 feet, forming the Lower or 
Great Falls of the Yellowstone. We are now face 
to face with one of the most beautiful scenes in 
the whole world — the Grand Canyon of the Yel- 
lowstone. This cleft is not so stupendous and 
sublime as the Grand Canvon of Arizona, but it 



-04 



■J'Hr<: HOSPITAL BULLETIN 




(ci.m;. vi:r.r.ii\v.sToxK vauk. 



is much more attractive. It is only about lo miles 
in length, 1200 feet in depth and less than a mile 
in width, but for brilliancy in coloring it is a 
mighty picture painted by nature's master artist 
and unapproachable by man. The prevailing 
color is a bright yellow, whence the name of the 
river and Park, but intermingled with reels and 
pinks, green and orange, white and brown, gray 
and purple, while the rocks themselves are sculp- 
tiu'ed l)y torrent and storm into manv fantastic 
forms. (Jne might well linger long here and mar- 
vel at the wonderful handicraft of nature and of 
nature's tiod. 

The new Canyon Hotel is an enormous struc- 
ture of ornate design, with every modern con\-e- 
nience. ICverything in the Park is under the con- 
trol of the ( "io\-ernmcnt : hence the charges for 



hotels, camps, conveyances and outfits are uni- 
form and imposition is almost impossible. There 
are permanent tent camps for those who prefer 
to live in a more rustic manner, and portable out- 
iits for those who long for the still simpler life. 
Our fourth day's journey was a long one, from 
the canyon to Xorris Geyser Basin and thence to 
the Mammoth Hot Springs. Xorris Geyser Basin 
is situated along the upper reaches of the Gibbon 
Rix'er. which unites with -the I'irehole River to 
form the IMadison, and all the most important 
geysers and hot springs drain into these streams. 
This region is also very remarkable, as here are 
found a large number of geysers that are in almost 
constant eruinion, and are evidently due to .shal- 
low springs in caverns where the heated volcanic 
rocks are verv close to the surface. In fact, one 




CA.WON Flto.M r.Ui.NK. V ICLI.nW Sl( iM ) l'.\l!K. 



THE HOSPITAL BULLETIN 



20; 



must walk on boards over tliis tliin crust under 
the direction of a guide, and one realizes some- 
what the significance of the old adage, "walking 
on a volcano." The Constant Geyser erupts about 
every minute, the Minute Man every one and a 
half minutes, but they only project their columns 
15 to 20 feet upwards. There is here also a very 
peculiar geyser that erupts cold water, but it is 
ejected by steam. The Black Growler emits a 
peculiar sound, as well as a vile odor. Numerous 
other geysers and pools of interest and beauty are 
found here, but we must resume our journey after 
a substantial lunch. The 20-mile drive to Mam- 
moth Hot Springs and Fort Yellowstone is re- 
plete with interest. The twin lakes are two bodies 
of water connected with each other, one of a beau- 
tiful deep blue color, the other greenish in tint. 
The road passes also Beaver Lake, which is an 
artificial lake made by beavers damming a stream 
and with a colony of beavers still occupying a 
house on its bank. Obsidian Cliff is a mountain 
of volcanic glass, rising to a height of 250 feet 
and with its exposed face 1000 feet in length. 
The color of the obsidian is mostly black, with 
lighter streaks traversing it. As blasting is not 
permitted in the Park, a roadbed was made by 
building great fires around the blocks of glass and 
then dashing cold water upon them, thus shatter- 
ing the brittle mass. In former days Indian tribes 
frequented this place to make arrowheads and 
other implements of this material. It is said it 
was neutral ground, used in common by all the 
Rocky Mountain tribes. Near this cliff one stops 
to drink from the appollinaris spring, which is a 
pleasant water, but not eflfervescing as far as I 
could judge. Numerous high mountain peaks are 
to be seen on this drive, the loftiest of which is 
Electric Peak, over 1 1 ,000 feet in altitude. Trav- 
ersing Swan Lake Basin, a high moimtain prairie, 
we come to Golden Gate Canyon and Viaduct. 
The roadway here is blasted from the rocks and is 
carried around the most difficult projection on a 
beautiful viaduct. This narrow pass is called the 
Golden Gate on account of the prevailing coloring 
of the rocks. The road now passes through a 
wild stretch of fantastically broken boulders, then 
throiigh a gap in the silver-gray rocks known as 
the Silver Gate, and rapidly descending we reach 
the Hot Spring Terraces, and soon alight at the 
Mammoth Hotel. This place is but five miles 
from the northern entrance to the Park at Gardi- 
ner, and one might well leave the Park bv this 



exit and take the Northern Pacific Railroad to 
St. Paul, but our itinerary called for a return to 
Salt Lake City and another long coach ride to 
the western portal at Yellowstone. There are no 
large geysers at Mammoth Hot Springs, but a 
series of remarkable terraces and pools, from 
which hot water is constantly running. The hot 
water holds carbonate of lime in solution, and as 
it escapes the lime is deposited, forming chalky 
mounds, beautifully terraced. Where the forma- 
tion is old and dry it is pure white in color, but 
where the hot water runs an algous growth forms. 




GIANT GEYSEK, YELLOWt>TOXE PARK. 

and the terraces are yellow, brownish red or 
greenish lined. These terraces are very extensive 
and cover acres of surface, and rise to a consider- 
able height. The most prominent ones are Ju- 
piter and Minerva terraces, but there are a num- 
ber of others. The Devil's Kitchen is the crater 
of an extinct spring into which one can enter, but 
the atmosphere is hot, damp and evil smelling, 
and when you have descended into its depths you 
wish you had not done so. The Devil's Thumb 
and Liberty Cap are peculiar upright formations, 
the cones of extinct hot springs. Fort Yellow- 



2o6 



THE HOSPITAL BULLETIN 



stone is the military lieadquarters of the Park, 
and several troops of cavalry are stationed here to 
police the Park and prevent disorder and poaching. 
The penalty for killing wild animals is very se- 
vere and is rigoroush- enforced. We saw a drove 
of 17 buffaloes grazing here, several of them hav- 
ing only recently been captured and placed with 
the tamer animals. 

After a good night's rest we were up early and 
off by 8 o'clock on our last day's ride of 46 miles. 
We retraced our steps to Norris Geyser Basin, 
reviewing the scenes of the previous da}', and 
thence to the railroatl terminus. The route along 
the Gibbon River and through the Gibbon Canyon 
was interesting and pretty, but the road was dusty 
and the trip tiresome, and we were glad to reach 
our destination about 5.30 P. M., having driven 
46 miles since leaving Hot Springs. After regain- 
ing possession of our belongings at the station and 
getting a substantial dinner, we entrained for Salt 
Lake City. 

There is so much to be seen in the Yellowstone 
Park and .so little time in which to see it that one 
gets a very superficial and confused idea of its 
wonders and beauties. Indeed, there are many 
beautiful mountains, valleys, lakes and waterfalls 
that the ordinary visitor does not see at all. Not 
far off the line of travel and readily accessible as 
a side trip is a stancling forest of petrified trees, 
as well as others where the trees are thrown down 
and shattered. To obtain a reasonably accurate 
idea of the Park would require at least a month's 
sojourn in the summer time. In the winter it is 
covered with many feet of snow, and is not open 
to the public, though the Government officials and 
soldiers remain at Fort Yellowstone. 



ACCTE FLEXURES OF SIGMOID AND 

COLON DIAGNOSED BY THE 

PROCTOSCOPE. 



Dr. Milton Morris Whitehurst, class of 1899, 
has just opened the Liberty Bell Candy Store 
and Lunchroom on Lexington street, near 
Charles. The place is immaculate and most taste- 
fully arranged. The team of oxen, drawing a 
cart on which is mounted a replica of the Liberty 
Bell, which is seen daily on the streets as the ad- 
vertisement of the place, is exciting much interest, 
as its quaint and slow plodding is so distinct from 
the average sight which greets the Baltimorean's 
eye. Another huge bell is swung over the door, 
and one almost imagines they hear its sound on 
a windy day. ^^'e wish Dr. Whitehurst all 
success. 



By J. Dawson Reeder, M.D., 
Baltimore. Md. 



The term itself describes the condition — a sud- 
den or sharp bend of the gut upon itself, narrow- 
ing or obliterating the caliber. The role in the 
]iroduction of disease, which is attributed by in- 
ternists to the absorption of retained, fermenting 
or putrifying fecal matter, rentiers any study 
throwing light upon these cases both interesting 
and important. It has been my good fortune to 
have under observation several cases which were 
so diagnosed by use of the pneumatic proctoscope, 
and subsequent operation verified the condition 
without a single exception. 

Flexures may be congenital or acquired. The 
congenital are all due to the turning of the rec- 
tum to the left at its upper end, and thus bringing 
the two fixed ends of the sigmoid in close apposi- 
tion, so that the long loop in between is necessarily 
acutely flexed either when it rises into the abdom- 
inal cavity or drops into the pelvis. In reviewing 
the literature upon this subject I was surprised 
to find that the greatest number of cases reported 
by any one author were by Tuttle of New York, 
who gave in the Nczv York Medical Journal of 
]\Iarch, 1908, a series of 11 cases. It is also es- 
pecially interesting to find that nearly every case 
gives identically the same history, especially if 
proctoscopic examinations are compared. 

The cases under my observation, which I will 
report in detail below, have been entirely con- 
fined to the sigmoid, while those by Tuttle have 
included cecum and sigmoid, but their histories 
are very similar in every respect. Inflammation 
of the pelvic organs, oophoritis and salpingitis 
may extend to the sigmoid and cause adhesions 
and angulations of any degree, and are the most 
frequent causes except, perhaps, local or general 
peritonitis, when there is no disease of the sig- 
moid itself. 

Adhesions of two or more appendices epi- 
ploicae, were found by Tuttle to have caused most 
distressing symptoms. Chronic appendicitis, if 
not a cause, is at least a comparatively frequent 
complication, producing flexures of the right side. 
One of the chief causes of constipation, and that 
to which more importance is attached than any 



Tin-: HOSPITAL BULLETIN 



207 



oilier mechanical nhstniclion. except, perhaps, 
stricture, is acute flexure at recto-sigmoidal angle. 

In the normal condition llio emjity sigmoid lies 
in the pelvis, between the rectum and bladder or 
uterus, thus causing an acute flexure between 
these two organs-. In cases of pelvic inflamma- 
tion it not infre(iuently happens that it becomes 
adherent to the rectum or to the floor of the pel- 
vis, thus becoming limited in its motions and pre- 
vented horn rising into the abdominal cavity. 
This can easil\- be tlemonstrated with the pneu- 
matic proctoscope. Where the pelvic colon is 
normally mobile inflation will cause it to rise into 
ihe abdominal cavity, especially if in the knee- 
chest position, and the straight tube can easily be 
introduced to the extent of 10 inches. When, 
however, on account of such adhesions, obstruc- 
tions in the fi^rm of tumors, etc., this flexure can- 
not be straightened out, it is very difficult or prac- 
tically impossible to pass the tube further than 
four or five inches. Tuttle reports one case in 
which the sigmoid was prevented from rising by 
the vermiform apyjendix passing down across its 
anterior surface and adhering to the peritoneum 
of the pelvis, just to one side of the bladder. At- 
tempts were made during several months to pass 
the straight tube into the patient's rectum, and 
they always caused great pain until the appendix 
was removed. As soon as this was done the sig- 
moid was sutured to the abdominal wall ( sigmoid- 
opexy), and when the patient had recovered from 
the operation it was possible to introduce the tube 
without any difficult}'. Nearly every case that I 
have seen presented a large band of adhesions 
from one-half to three inches in breadth, extending 
from the left iliac fossa around a knuckle of sig- 
moid. These bands form a distinct mechanical 
obstruction, especially when the gut becomes dis- 
tended with gas, and the entire obstructed area 
can be distinctlv palpated on abdominal wall. 

Syiiif^tonis. — There is always constipation or 
fecal stasis, distension and history of previous pel- 
vic disturbances. In the congenital type, which 
the specialist rarely sees in early life, there is 
always history of colic, distended abdomen and 
constipation, accompanied with indigestion. As 
the child grows up it is called chlorotic, but is 
really toxic from absorption of produccts of re- 
tained feces. If a girl, there is usuallv delayed or 
irregular menstruation, imperfect development 
and often intractable leucorrhea. The constipa- 
tion, flatulence and colicky attacks persist. In 



the ac(|uired angidations there is usually in addi- 
tion to the constipation and distended sigmoitl a 
history of dysentery, typhoid, colitis, sigmoiditis, 
pelvic peritonitis or inflammation of pelvic organs. 
The patients are constipated, muddy complex- 
■ioned and have white tongues, flatulence and pass 
more or less mucus with their stools, the latter 
often being their most distressing symptom. 

Examination may not show any hemorrhoidal 
or other abnormality of the rectum, and Mpus- 
ton"s valves may be soft and [iliable ; but it always 
shows some point near recto-sigmoidal juncture 
where the tube is obstructed against gut wall, and 
even with atmospheric distension we dare not use 
further force in trying to pass the tube beyond 
this point. Often there are abrasions or ulcera- 
tions at the angulation, .\nother s_\m]}tom of 
which many complain is incomplete evacuation ; 
they go to stool four or five times daily to pass 
what amounts to an ordinary stool : thev even 
have to go several times to relieve themselves of 
a high enema. 

Among the causes reported by Tuttle are the 
following interesting ones : 

1. Extensive adhesions of sigmoid to vertebral 
column. 

2. Acute flexure of sigmoid, due to close appo- 
sition of its fixed point with long mesentery to 
intervening- loop. The flexure at both its points 
is occasioned by accumulation of gas and lifting 
up of the long loop into the abdominal cavity. 

3. Acute flexures of sigmoid frojn adhesions 
between appendices epiploicae. 

4. Acute flexures of sigmoid on right side; 
chronic appendicitis. 

5. Adhesions of sigmoid to tubes and ovaries. 

6. Large band of adhesions binding sigmoid 
down into left iliac crest — Dr. Wyeth's case. 

In the cases operated upon in the L'niversity 
Hospital I have been unable to pass the lo-inch 
sigmoidoscope farther than about four or five 
inches beyond the sphincter even w'ith pneumatic 
dilatation, anfl several of these were under anes- 
thesia with parts perfectly relaxed. In presenting 
these facts I do not wish to convey the idea that 
diagnosis of these conditions can only be made by 
the aid of the proctoscope, as the history of pre- 
vious inflammation and palpation of a dough\' 
mass in the region of the sigmoid will readil.' 
suggest the condition present, but failure to intro- 
duce a straight tube is absolute proof of existing 
obstruction. 



208 



THE HOSPITAL BULLETIN 



The majority of cases seen and operated upon 
have been under the care of Prof. St. Clair 
Spruill, who was first to call attention to this con- 
dition about five years ago in the case of Dr. S., 
who gave all of the symptoms above noted, and 
proctoscopic examination at that time resulted in 
diagnosis of cancer. Dr. S. was opened at St. 
Joseph's Hospital and a large band of adhesions 
was found, completely encircling a large portion 
of gut and binding it down to left side of bladder, 
then reflecting over anterior abdominal wall. The 
adhesions were broken away, all raw surfaces cov- 
ered over with peritoneum and abdomen closed. 
Patient rapidly improved and all symptoms com- 
pletely disappeared. 

Case Xo. 2. — A. F. ; male ; aged 24 -years. 
March 30, 1910. Occupation, conductor. x\t- 
tending surgeon, Prof. St. Clair Spruill ; assistant, 
Dr. Hooper. Complaint, "pain in left side." 

About five years ago patient was suddenly 
taken with pain in upper left side of abdomen, 
extending through the back and down left thigh. 
This continued for about three days, there being 
a constant ache all the time, with paroxysms of 
very sharp jiain, which were so severe as to cause 
patient to double up. He stated that during this 
period he would void his urine about every 12 
hours; just before micturition he would have se- 
vere paroxysms of pain. Patient was free for 
some time of these pains until last June, when he 
was taken exactly similar to above described, 
compelling him to lay up for a complete rest of 
several days. In July he went to a hospital and a 
cystoscopy was done. He stayed only a few days 
and left in same condition. 

Entered University Hospital, and April 3, 1910, 
Dr. .Ashbury made following report of X-ray No. 
689 : Negative for stone in left ureter and kidney ; 
two masses located upon sigmoid and descending 
colon, which may be foreign bodv in colon or sur- 
rounding structure. X-ray No. 689, second : Ex- 
tended shadow of psoas muscle ; otherwise nega- 
tive. The two masses above mentioned are not 
shown. 

.•\pril 9, 1910; Patient taken to operating- 
room at 10.30 A. M. ; prepared in usual manner. 
Incision made in left side, parallel to median line, 
through left rectus muscle alwut five inches long, 
i'eritoneal cavitv opened and contents of left 
lower (|uadrant examined thoroughly. 

The sigmoid was found to be adherent both to 
the bladder and side of pelvis. These adhesions 



were broken up with considerable difficulty, the 
raw surfaces covered with peritoneum, the abdom- 
inal cavity thoroughly cleansed and the abdomen 
closed. — Dr. Hooper. Patient did very well ; suf- 
fered for several days with retention and had to 
be catheterized. 

i\Ia\' 6, 1910: After castor oil was freely ef- 
fectual no bad after-results noted. Symptoms 
cleared up and appetite became good ; bowels reg- 
ular. No abdominal pains whatsoever. Dis- 
charged May 9, 19 10, cured. 

Case No. 3. — Milton D.. aged 35 \ears. May 2. 
1910. 

Entered University Hospital complaining of 
pains in lower left quadrant of abdomen. Acute 
sharp pains would wear off in a few days, leaving 
a dull aching place, which would remain for a 
week or more. Attacks would become more fre- 
quent if patient allowed himself to become con- 
stipated. When his bowels were free his pain 
was markedly less, but always present. Also 
complained of pains in his hips and thighs ; was 
unable to walk more than 200 or 300 yards with- 
out feeling that .hips would give away ; his entire 
body felt tired. This disappears at night after 
rest, and he did not complain of dragging his feet 
when he walked. 

Lower extremities "go to sleep" very easily. 
Patient com])lains of dull aching pain across the 
back, which interferes with anything he attempts 
to do. 

.■ibdomcn. — Intercostal angle wide; abdominal 
walls of good tone ; no muscle spasm. In left 
lower quadrant of abdomen, just above the crest 
of ilium, there is noted on deep palpation a definite 
mass, movable, tender and seemingly round. 
Nothing else abnormal noted in abdomen. — Dr. 
Hooper. 

Diagnosis. — Refle.x spinal irritation, due to 
dragging of mesentery of signnoid and descend- 
ing colon. — Dr. Spear. 

May 5, 191 1 ; Patient was prepared for opera- 
tion at 10.30 A. M. by Dr. Spruill. His abdomen 
was opened on left side through the rectus mus- 
cle ; contents of left side of abdomen examined. 
The sigmoid was found to be twisted upon itself 
and tied down to side of pelvis with adhesions. 
These were broken away and raw surfaces cov- 
ered over with peritoneum. On close examination 
the sigmoid was found to be thickened on one 
side, as was the mesentery of this region ; the 
mesentery was pulled down over the bowel and 



THE HOSPITAL BULLETIN 



209 



held in place by beins: attached to the peritoneum ; 
abdomen closed with silk sutures and skin with 
silver wire. Patient returned to l^ed in very tjood 
condition. 

Alay 21, Kjio: Patient discharged; condition 
cured. At time of discharge he was in excellent 
condition, presenting none of the symptoms. 

Diiii^nosis. — L'lcer of sigmoid, with adhesions 
to side of pelvis. 

Case Xii. 4. — Mrs. P.; aged 31 \ears ; Wal- 
hrook, API.; attending surgeon. Dr. Spruill. 

May 18, 1910: One week prior to entrance \ia.- 
ticnt was taken suddenly in the middle of the 
night with stabbing pain in the left side of the 
abdomen. The pain was so severe that, according 
to her statement, patient was thrown into convul- 
sions. She then noticed a feeling of fullness in 
the lower left quadrant of the abdomen, as if a 
large mass were there : tlie above-mentioned pain 
radiated down her left limb and up her left shoul- 
der, and she seemed verv much distended with 
gas. The pain lasted for about an hour, when a 
])hysician was called in and administered morphia, 
which gave relief. The following day the jjatient 
felt verv badly, the pain was still present, and 
she w'as generally uncomfortable. On that day 
she had one severe paroxysm of pain, and from 
then to the present time has had from one to 
three attacks every da}'. She was always more 
or less constipated, and preceding the initial at- 
tack her bowels had not moved for over 24 hours. 
Patient suffered from some headache during 
these attacks. She complains now of aching in 
lower part of her back. Two years ago the pa- 
tient was operated upon ; her tubes and ovaries 
were removed. A month or so after the opera- 
tion the patient noticed that she was constipated, 
and had to take medicine of some character con- 
stantly for this trouble. She also began to suffer 
from acute indigestion. 

No pulmonary complaints ; no genito-urinary 
complaints ; no cardio-vascular symptoms. Past 
history negative (except before-mentioned opera- 
tion ) . Family history negative. 

Intercostal angle wide; abdomen prominent, 
with very large amount of subcutaneous fat ; pain 
on left side on deep pressure, and in lower left 
quadrant was found an ill-defined soft mass easilv 
palpated. 

No glandular enlargement ; spleen and kidneys 
not palpable. 

June 19, 1910: Patient was taken to the oper- 



ating-room, placed on table and anesthetized with 
ether. Abdomen cleansed in the usual manner. 
An incision about seven inches long was made 
through the left rectus muscle, peritoneal cavity 
ojiened and its contents exjjlored. The sigmoid 
was found tied up with adhesions to the side of 
])elvis and bladder. These adhesions were broken 
and the raw surfaces covered as well as possible 
with peritoneum. The peritoneal cavity was 
closed with fine silk, muscles and fascia with me- 
dium silk, and skin with subcutaneous silver wire. 
The patient was returned to bed in good condi- 
tion. 

July 8. 1910: Patient discharged; condition 
cured. 

Case Xo. 5. — Miss H. ; aged 21 years: city. 
Patient, a small girl of poor stature, who had been 
ill for some months. Previous to the examination 
she had been operated upon several times for peri- 
tonitis and post-operative adhesions. At the re- 
quest of Dr. W. K. White, I proctoscoped the pa- 
tient at her residence, but was unable to introduce 
my straight tube farther than about five inches. 
The patient had been confined to bed for some 
months, suffering from nausea, vomiting and ex- 
treme mucous colitis. .\ laparotomy was advised 
after tonic treatment and rest. The patient was 
taken to St. Joseph's Hospital and opened by Dr. 
Spruill. 

A large ulcer was found in the stomach, for 
which he did a gastro-enterostomy, and upon ex- 
ploring the pelvis he found a large knuckle of sig- 
moid, bound down in the left iliac fossa, com- 
pletely surrounded by adhesions, which extended 
over to the bladder. These were broken and the 
abdomen closed in the usual manner. The patient 
at last report was improving rapidly, and promised 
to be a cure. 

Case No. 6. — Mrs. C. C. H.; aged 45 years; 
Hyattsville, Md. Referred to me by Dr. T. E. 
Latimer, Hyattsville, Md. Attending surgeon, 
Dr. Reeder. November, 19 10. 

Patient was a very small ill-nourished woman, 
the mother of three children, whose ages ranged 
from 14 to 19 years. Since birth of last child she 
has suffered continuously of pain in abdomen, 
constipation and loss of weight, which has been 
gradually increasing in severity. Was called to 
Hyattsville by Dr. T. E. Latimer ; found patient 
confined to bed, where she had spent best part of 
past three months, nervous and emaciateil, her 
mental symptoms having become so pronounced 



210 



THE HOSPITAL BULLETIN 



that the family had hfgun to give it serious con- 
sideration. 

Patient presented a sallow, dried-out appear- 
ance, tongue white, thick and furrowed ; e}"es dull 
and listless, with marked nervous tremor of ex- 
tremities : intercostal angle narrow and body ill- 
nourished. 

In left lower quadrant of abdomen, above the 
crest of ilium, was noted a rigidity which, upon 
deep palpation, presented a doughy mass, freely 
movable, but painful. With the assistance of Dr. 
Latimer patient was placed in knee-chest position. 
and our attempt to pass lo-inch sigmoidscope 
resulted in failure, as it would not pass beyond 
the second portion of rectum even under atmo- 
spheric distension. 

Patient here stated that the dragging-down sen- 
sations caused nausea and feelings of suffocation. 

Her bowels only moved about every four to 
six days, and then only bv use of a purgative. 
This condition had existed for the past four years. 

Operation was advised after patient had re- 
ceived tonic treatment and purgation. January, 
191 1, ])atient was taken to Sibley Hospital, Wash- 
ington, D. C, and prepared for operation. With 
the assistance of Dr. Latimer and the house staff 
of the hospital I opened abdomen by left rectus 
incision ; peritoneal cavity was explored, and a 
large band of adhesions extending from recto- 
sigmoidal angle was found, extending over broad 
ligament, and fundus of uterus closely adhering 
the rectum to uterus and blackler. Adhesions 
were broken away and dissected out ; raw surfaces 
covered over with peritoneum and held by fine 
silk. Region of appendi.x was then explored, and 
presented a thickened, bluish appearance, which 
caused us to remove appendix. Abdomen was 
closed in usual manner and patient returned to 
bed. 

( )n morning of fourth day saw the patient for 
the first time after operation, and found temjicra- 
ture normal, but patient suffering great pain from 
gas and distension jiroduced by laxative, which 
up to this time had not been effectual. Enema of 
10 |)er cent, hydrdgcn peroxide was ordered, bin 
before it had been administered bowels movetl 
and patient was inunediately made comfortable. 
Improvement from then was rapid and unevent- 
ful, and ])atient was discharged from hospital on 
tenth day. Her bowels moved daily without laxa- 
tives and her color was greatly improved. My 
last rejiort fmni Dr. Latimer savs she is attendiu"' 



to all her household duties, has gained rapidlv in 
weight and her mental condition has completely 
cleared ; bowels move regularly without aid of 
purgatives, a condition which has not existed for 
at least four years. 

Diagnosis. — .\dhesions of sigmoid. 

Result. — Cured. 

Coiu'hisioiis. — In presenting the series I do not 
wish to convex' the idea that proctoscopic exami- 
nation is absolutely necessary, but do claim that 
it makes diagnosis absolutely positive. If you fail 
to pass the lo-inch sigmoidoscope without giving 
pain, you must at once eliminate possible stricture 
or malignity. 

Xo physician in general practice is justified in 
prescribing for rectal disease upon the patient's 
diagnosis of internal or bleeding piles, as many 
an operable case of cancer has been so treated 
when, six months later, the unfortunate individual 
must be condemned to death. Many cases of so- 
called neurasthenia have a definite pathologic 
cause, the intestine being the most frecjuent seat. 

Dr. Axtell's article from Dillingham, Wash., 
stating that adhesions of sigmoid are a frequent 
cause of epilepsy should receive inost careful and 
serious consideration from every physician and 
surgeon. 

The partial list of cases as above reported are 
conclusive evidence of the value of proctoscopic 
examination, and my list of examinations made 
at the University Hospital and Bayview have had 
their diagnosis confirmed by the surgeons whom 
I have had the honor to serve, and it is quite evi- 
dent that this i^rocess will in the very near future 
be a part of the routine examination of every pa- 
tient admitted to hospitals for treatment where a 
general physical e.xamination is required. 

Professional Building. 

Baltimore, Md. 



Dr. John .\ldridge (iibson, class of 1901, of 
Leesburg, \'a.. writes : "I am enclosing a clip- 
ping telling of the death of poor Joe Milton. It 
has broken me all up. as a finer fellow never lived. 
I have just gotten over an attack of appendicitis, 
and back tn work again, feeling the worse for 
wear, although I was in the hos])ital only nine 
ilays. I was shot into the lios])ital six hom-s after 
I was taken, and consequently had a perfectly 
clean case." 



THE HOSPITAL BULLETIN 



2T t 



[IE lACKSOXLW METHOD OF AMPU- 
TATION OF THE BREAST FOR MA?^!- 
MARY CANCER. 



r>y Wir.i.is Linn, 
Senior Medical Student. 



When one is asked to prepare a paper on a 
subject that one knows little or nothing about, it 
lieconies by the nature of things that the work 
will all he second-hand, and whether it conies 
from the textbook, from the journal or from the 
teachers matters little. Realizing that probably but 
one man out of every fifty that graduates in medi- 
cine practices major surgery to any extent what- 
ever, and that no more than one out of every hun- 
dred will ever do any operation exactly as it is 
set down on paper, I shall endeavor to give only 
the operation in the words of its originator, J. W. 
Jackson, M.D.. of Kansas City. Mo., leaving dis- 
cussions and modifications for wiser heads than 
mine. According to Jackson {The Journal of the 
Aineriean Medical Association of January, 1910), 
the technicjue is as follows : 

Before proceeding with the operation itself, 
he finds it a great advantage to first mark oH with 
a single scratch the complete plan of skin incision. 
Being careful that the portion of the incision 
which surrounds the breast is always carried be- 
_\ond the bounds of the breast itself, so that all 
premammary skin is removed with the tumor, the 
skin incision is begun at a point about one and 
one-half inches below the middle of the clavicle, 
between the clavicular origins of the deltoid and 
the pectoralis major. From this initial point the 
incision is carried outward and downward with 
a slight curvature, whose convexity is outward 
and overlapping the inner margins of the deltoid 
nniscle to the outer edge of the lower border of 
the pectoral fold. The incision is now curved 
around the outer edge of the pectoralis dissec- 
tion and reaches slightly under the edge of the 
jiectoral fold. Along the under margin of this 
fold it is carried to the chest wall, where it meets 
with the outer circumference of the breast near its 
lower border. The remaining portion of the in- 
cision is made in the form of an ellipse about the 
breast, with its long axis somewhat from above, 
downward and outward, so the outer portion of 
its circumference partially parallels the descend- 



ing first incision. In operating, this descending 
incision alone is made at the beginning of the 
operation. With the incision thus far carried, he 
has fashioned a quadrilateral ilap with its base 
upward toward the clavicle and free below. This 
incision is carried through skin and superficial 
fascia down to the underlying muscles. This flap 
is then dissected upward from below, and above 
its base the skin is undermincfl well up to the 
clavicle. The flap is then wrapped up in hot salt 
towels to prevent any possible contamination in 
subsequent stages of the operation. \Vith this 
ilap lifted the pectoralis major muscle is exposed, 
with its fibers converging to its tendinous in- 
sertion in the humerus. The index finger of one 
hand is now shoved up underneath the pectoralis 
major and brought out again at its upper border, 
so that the entire pectoralis muscle is thus hookeil 
up bv the index finger and by blunt dissection 
separated out to its tendinous insertion. With 
the tendon of the pectoralis muscle thus lifted up, 
it is now divided by the scalpel very near its ten- 
dinous insertion with the humerus. The muscle 
retracts toward the chest and exposes the pec- 
toralis minor invested in its fascia, which above 
runs to the clavicle and below spreads over the 
chest wall. The pectoralis minor is now iso- 
lated, as was the pectoralis major. It is also 
divided close to its attachment to the coracoid 
process of the scapula. As the pectoralis minor 
also retracts towards the chest, as did the pec- 
toralis major, the wound is held apart by re- 
tractors or by the fingers of an assistant, and the 
axillary space is now widely exposed to view from 
the front. 

As a rule, this exjiosure can be made without 
encountering any bleeding vessels which will re- 
c|uire clamp or ligature. The axillary vein is now 
in view, and to its outer side and parallel to it an 
incision is made with the scissors of the fascia 
which surrounds the vessels. The fascia is now 
stripped olt. The operator works steadily from 
without and above downward and inward toward 
the chest, and clearing fascia and glands. As he 
goes in this way the axillary artery and vein are 
isolated, and the branches supplying the axilla 
and going on to the chest are made plainly ap- 
parent. These vessels are at once double clamped 
and divided between clamps. He has usuall\' 
found it necessary thus to ligate three or four sets 
of vessels. Time is saved by immediately ligating 



212 



THE HOSPITAL BULLETIN 



these vessels and then removing the clamps. 
Thereafter there will be no trouble with hemor- 
rhage from the axilla. Beginning thus at the apex 
and outer border of the axilla, the fascia and 
glands are completely cleaned by gauze, and scis- 
sors dissection working from the vessels inward 
toward the chest ; this dissection should clear the 
subscapularis. serratus magnus and intercostal 
muscles of all connective tissue and fat cells as 
the dissection proceeds. The raw surfaces left 
are covered progressively with hot packs both to 
the proximal and distal wound surfaces, thus 
guarding against wound contamination. The dis- 
section is now usually continued with gauze up 
under the pectoral muscles, under the breast 
and towards the chest. The point of attach- 
ment of the pectoral minor to the ribs is 
cut from underneath, flush with the ribs and 
the costal muscles from underneath. The 
operator now loosens up the pectoralis major 
to its fixed point of origin from the clavicle 
and sternum. While this is being done the breast 
is forcibly pulled back, so as to expose the deep 
cavity of the wound. The pectoralis muscle is 
now severed from beneath, close to its lines of 
bon}' attachment, and the perforating branches 
of the internal mammary are caught as soon as 
divided, as they come through the chest wall. 
After the pectoralis muscle has been entirely sep- 
arated from beneath, the breast is allowed to drop 
back into its normal position. The skin incision is 
completed, dissected widely in every direction, 
and the breast and pectoral muscles underneath 
are removed. Branches of the mammary artery 
are now tied and forceps removed. Under these 
circumstances, the skin incision practically does 
not bleed at all, and it will be noticed that at no 
time during the operation were there more than 
a dozen clamps on the wound ; in fact, if all vessels 
were tied when cut, it would be possible to do the 
operation with half this number, as the vessels 
when tied are tied at the base instead of tying 
innumerable branches, as is usually done. The 
removal of the infected tissue being now complete 
and the wound dry, the next step is the replacing 
of the flap and closure of the wound. The quad- 
rilateral flap of skin and superficial fascia which 
formerly covered the axilla is now stretched out 
with tenaculum forceps and made to cover the 
defect of the chest wall created by the removal 
of the skin of the breast. This flap, which is one 
of three distinctive features of the operation, will 



always contract after it has been once loosened 
and will look as though it could be of little 
service. A couple of tenaculum forceps at the 
angles will spread it out, so it will cover a sur- 
prising amount of space. As the flap is now- 
drawn over the chest he usually fixes it bv attach- 
ments to the corresponding skin margins. An- 
other distinct point now consists in catching up 
with a tenaculum the margins of the lower border 
of the pectoral fold, which represents the integu- 
ment which originally formed the floorof theaxilla. 
The skin is then stretched upward to the original 
skin beneath the clavicle. This brings the loose 
skin in the floor of the axilla up around the axillary 
-vessels, and does away entirely with the axilla as 
a cavity in the subsequent anatomy of the indi- 
vidual. These tenacula likewise are usually 
clamped, and mark these fixed points of coap- 
tation. Figure of eight tension sutures of silk- 
worm gut are placed at these points to steady sub- 
sequent suturing. The remainder of the incision 
is closed with subcuticular sutures of silkworm 
gut. Drainage may be left by a stab puncture in 
the lowest recesses of the wound space, or may 
be done away with entirely. The wound is now 
covered by large square pads of gauze, wrung dry 
out of hot salt solution and finally strapped tightly. 
Separate pads cover the arms, so as to allow free 
mobility. When the operation is completed it will 
be observed that there is an appearance which is 
likened to that of a dipper with its handle running 
vertically along the inner border of the area. In 
conclusion, this method has the following ad- 
vantages : 

"First. The drawing of the skin over the axilla 
does away with a space which otherwise nature 
would have to fill in with scar tissue. 

"Second. The flap forms a covering for the 
chest defect without an\- tension, and this does 
away with the necessity of grafting, which is so 
frequent in other methods. 

"Third. The ligation of all vessels at their 
nearest point of origin, thus doing away with the 
ligating of so many vessels. 

"Fourth, and lastly. The entire technical por- 
tion of the operation is completed before the chest 
is exposed by removal of the breast. Therefore, 
long ex])osure of an enormous area of raw surface, 
with the attending shocks, is done away with. As 
soon, in fact, as the breast is removed the wound 
is ready to be closed." 

.Students' Building, November 17, 1910. 



THE HOSPITAL BULLETIN 



213 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, January 15, 1912. 



•SPEED FORTH THE SIGNAL! CLANS- 
MEN, SPEED!" 



The Christmas hoUdays have come and gone, 
and the joys and happiness of the yuletide are but 
pleasant memories. We hope that much of the 
])leasure of the season has been derived from the 
bestowal of benefits upon others rather from the 
gifts that we have individually received. The 
practice of giving and receiving gifts at Christmas 
has become so universal that it imposes heavy 
burdens, at times, on those who are but ill pre- 
pared to bear them. Recognizing that December 
was a month in which our friends would have 
additional demands upon their means on account 
of the festivities of tjie season, we did not make 
much effort to push along our campaign for the 
pathological endowment fund, but nevertheless 
fared much better, both in subscriptions and in 
cash collections, than might have been expected. 
Now that the new year has opened to us, we hope 
we may succeed in a measure commensurate with 
the urgency and importance of the object we have 
in view. The writer possesses zeal and loyalty, 
but he lacks the necessary tact, influence and abil- 
ity to carry the enterprise to a successful conclu- 
sion. He therefore not only solicits the aid of his 
colleagues and friends, but must have assistance. 
The work of raising this fund is difficult and not 
pleasant, but the necessity is great. We have 
lighted and raised aloft the flaming torch, and 
we now ask our loyal friends to speed the signal. 
"Speed forth the signal ! Clansmen, speed !" 



The subscriptions to January i, 1912, are as 
follows : 

Robinson bequest $5,000 00 

Dr. Hugh Hampton Young, J. H. U 100 00 

Prof. R. Dorsey Coale, Ph.D 100 00 

Dr. S. J. Meltzer, LL.D., New York ... 10 00 

Dr. Gideon Timberlake 25 00 

Dr. Gordon Wilson 50 00 

Mr. H. P. Ohm 10 00 

Dr. Samuel W. Moore, D.D.S 25 00 

Dr. A. Sagebin. D.D.S. , Cuba 5 00 

Thomas C. Basshor Company 10 00 

Hospital Bulletin 10 00 

Maryland Medical Journal 5 00 

Miss C. M. Selfe 5 00 

Mr. Geo. Lewis, Florida 5© 00 

Mr. J. Henry Smith 25 00 

Mr. R. A. Krieger 5 00 

Summers Printing Co 15 00 

Williams & Wilkins Company 50 00 

Geo. W. \\'alther & Co 15 00 

Muth Bros. & Co 10 00 

Dr. John J. R. Krozer. 1848 50 00 

Dr. Eugene F. Cordell, 1868 10 00 

Dr. John G. Jay, 187 1 25 00 

Dr. C. R. Winterson, 1871 10 00 

Dr. Joseph T. Smith, 1872 10 00 

Dr. W. J. Young, 1872 25 00 

Dr. Isaac S. Stone. 1872 10 00 

Dr. Thomas A. Ashby, 1873 100 00 

Dr. David W. Bulluck, 1873 100 00 

Dr. Robert Gerstell, 1873 5 00 

Dr. Randolph Winslow, 1873 100 00 

Dr. James W. Humrichhouse, 1873. ... 25 00 

Dr. H. T. Harrison, 1874 5 00 

Dr. John D. Fiske, 1875 5 00 

Dr. \\'ilmer Brinton, 1876 100 00 

Dr. Wm. E. Wiegand. 1876 10 00 

Dr. Thos. Chew Worthington, 1876. . . 5 00 

Dr. R. H. P. ElHs, 1877. .". 10 00 

Dr. L. Ridgely Wilson, 1880 5 00 

Dr. Charles W. Mitchell, i88r 100 00 

Dr. L. Ernest Neale, 1881 100 00 

Dr. E. L. Meierhof, 1881 50 00 

Dr. Jas. M. Craighill, 1882 25 00 

Dr. J. M. Hundley, 1882 250 00 

Dr. Henry Chandlee, 1882 25 00 

Dr. Chas. C. Harris, 1883 10 00 

Dr. B. Merrill Hopkinson, 1885 25 00 

Dr. J. C. Perry. 1885 100 00 

Dr. H. C. Reamer. 1885 10 00 

Dr. Frank Martin, 1886 100 00 



!I4 



TI-iE HOSPITAL BULLETIN 



Dr. John R. Winslow, 1888 50 00 

Dr. C. W. McElfresh. 1889 100 00 

Dr. Jos. E. Gichner, 1890 25 00 

Dr. St. Clair Spruill, 1890 150 00 

Dr. Rupert Blue, 1892 100 00 

Dr. Frank J. Kirby, 1892 50 00 

Dr. Andrew J. Crowell, 1893 10 00 

Dr. Walter B. Kirk, 1893 5 00 

Dr. Martin J. Cromwell, 1894 50 00 

Dr. Charles T. Harper, 1894 50 00 

Dr. Henry Lee Smith, 1894 10 00 

Dr. Harry Adler, 1895 100 00 

Dr. Jose L. Hirsh, 1895 50 00 

Dr. John McAIullen, 1895 5 00 

Dr. Joseph W. Holland, 1896 50 00 

Dr. R. W. Sturgis. 1896 2 00 

Dr. Guy Steele, 1897 15 00 

Dr. Page Edmunds, 1898 50 00 

Dr. Albert J. Bossyns, 1898 5 00 

Dr. L. W. Armstrong, 1900 10 00 

Dr. S. Demarco, 1900 50 00 

Dr. M. S. Pearre, 1900 S 00 

Dr. Irving J. .Spear, 1900 50 00 

Dr. William Tarun, 1900 50 00 

Dr. John Houff, 1900 25 00 

Dr. Wm. H. Smith, 1900 25 00 

Dr. J. D. Reeder, 1901 50 00 

Dr. Nathan Winslow, 1901 50 00 

Dr. Wm. R. Rogers, 1901 25 00 

Dr. Arthur JM. Shipley, 1902 250 00 

Dr. H. C. Davis, 1902 10 00 

Dr. H. L. Rudolf, 1902 25 00 

Dr. Hugh Brent, 1903 25 00 

Dr. G. C. Lockard, 1903 25 00 

Dr. Geo. S. M. Kieffer, 1903 25 00 

Dr. H. J. Maldeis, 1903 25 00 

Dr. Howard J. Iglehart, 1903 25 00 

Dr. Howard W. Jones, 1903 25 00 

Dr. John T. (.)'Meara. 1903 25 00 

Dr. Fred L. Wilkins, 1903 25 cx) 

Dr. Albert L. Wilkinson, 1903 25 00 

Dr. R. C. Metzel, 1904 '. 10 00 

Dr. Ejnar Hansen, 1904 10 00 

Dr. Charles Bagley, Jr., 1904 25 00 

Dr. Alvin B. Lennan, 1904 25 00 

Dr. Walter Van Sweringen, 1904 25 00 

Dr. M. A. Weinberg, 1904 23 00 

Dr. Herbert E. Zepp, 1904 25 00 

Dr. Robert P. Bay, 1905 100 00 

Dr. B. F. TefFt, 1905 100 00 

Dr. Edward L. Bowlus, 1906 S 00 

Dr. Jos. A. Devlin, 1906 to 00 



Dr. W. F. Sowers, 1906. 25 00 

Dr. R. \\'. Crawford, 1906 25 00 

Dr. Matthew L. Freilinger, 1906 10 00 

Dr. Leo Karlinsky, 1906 20 00 

Dr. J. P". Hawkins, 1906 25 00 

Dr. Richard C. Hume, 1906 10 00 

Dr. Frank S. Lynn, 1907 25 00 

Dr. T. H. Legg, 1907 5 00 

Dr. Albert H. Carroll, 1907 25 00 

Dr. Edgar S. Perkins, 1907 25 00 

Dr. ^^'. Cuthbert Lyon, 1907 5 00 

Dr. Thomas H. Phillips, 1908 25 00 

Dr. J. N. Osborn, 1909 5 00 

Dr. E. IT. Kloman, 19 10 25 00 

Terra Mariae, 191 1 3 50 

Total $9,275 50 

Additions for the month, $243. 



THE POE SCHOLARSHIP. 



l- 



The subscription committee is endeavoring to 
raise $1300 for the purpose of founding a schol- 
arship in the law department of the University 
of Maryland in honor of the late John Prentiss 
Poe, for more than 40 years a professor in that 
department. Mr. Poe was a public-spirited citi- 
zen and an ornament to the legal profession. Al- 
though not of our department or profession, the 
editor feels that many of our alumni were so well 
acquainted with Professor Poe that they would 
like to contribute to such a worthy cause. The dx' 
fund will be administered by the trustees of the 
Endowment Fund of the University of Maryland, . 
which ensures its perpetuity. ' 

The appeal is as follows : 

Dear Sir — The undersigned are establishing a 
John Prentiss Poe Schol.vrship at the Law 
School of the University of Maryland. We are 
all graduates of the 191 1 law class. Our class 
was the last to learn from the lips, now sealed by 
death, of this great man. 

Our plan is to raise $1300, which, at 5 per cent., 
would yield $73 per annum. The sum is to be 
handed over to the trustees of the Endowment 
Fund, who will pay the tuition fee of that Senior 
student who has obtained the highest rating in 
the first and second years' work. We decided to 
ask for only small contributions, so that all can 
share in this privilege and the interest in the Poe 
scholarship be widespread. 

W'e feel sure that all members of the Marvland 



THE HOSPITAL BULLETIN 



215 



Liar and alumni df ilic Law School of the old 
I'niversity of Maryland will, with pleasure, help 
in the estahlishnient of this scholarsiiip. Will 
\-ou contrihute $5? All money and checks are to 
be made payable in m\- name. Cyril llansell. 

Our clean (Judj^e ilarlan) and Juils'e Stock- 
bridge, among other i)rominent Maryland law- 
yers, have expressed their appreciation of our 
effiirls and api)roval of our plan, and have con- 
tributed to this scholarship. 

"\"ou can well understand that there is attached 
to our ]ilan ( involving, as it does, the approach- 
ing of so many peo])le) a great deal of work, and 
tlie favor of a prompt repl}' would be greatly 
appreciated. 

Courteously Aours. 

Cyril Hanseli.. Ciiairman : 
Edcj.vr H. McBride, 
Louis J. Jir.\. 
J. Stewart Glex, 
Charles H. Buck. 
George A. Rossixc. 
CvPRiAx W. ;McSherrv, 

Committee. 
300 W. Lanvale street, 

Baltimore. Md. 



break his arm while cranking his automobile some 
four weeks ago. 



ITEMS 



riie Xurses' Alunmae Association of the L'ni- 
versity of Maryland held their amiual meeting- 
January S. 1912. at the University Hospital. The 
following officers were elected for the ensuing 
year: President. ;\Irs. Page Edmunds (Millicent 
(ieare). class of 1905; first vice-president. Miss 
Alice F. Bell, class of 1907 ; second vice-president. 
Miss Mary Gavin, class of 1908; secretary, Miss 
M. (Jertrude Brady, class of 191 1 ; treasurer, Mrs. 
Nathan Winslow ( Margaret K. Massey), class of 
i<)03 : members of the executive committee. Miss 
-M. E. Rolph, class of 1895; Mrs. Ethel Palmer 
Clark, class of 1906; Misses Clyde C. Dawson, 
class of 1908, and Susan A. Hostrawser, class 
of 1908. 



Dr. Newton A\'. Herschner, class of 1906. of 
Mechanicsburg. Pa., and formerly assistant resi- 
dent physician in St. Joseph's Hospital, Balti- 
more, was a recent visitor to the University Hos- 
pital. Dr. Herschner was so unfortunate as to 



Dr. Albert G. Webster, class of 191 1, of David- 
sonville, Md., has rented the Presbyterian Manse 
at Churchville. Harford county. Md., and is prac- 
ticing there. Churchville is the center of a wide 
area formerly covered by three physicians, of 
whom only one now is living ; so doubtless Dr. 
Webster has selected a likelv location. 



Dr. Harry Dorsey Purdum. class of 1902, at 
present chief resident physician at Bayview Asy- 
lum, has been appointed assistant physician and 
pathologist U) the Springfield State Hospital. 



Amongst our Louisiana alumni are : 

^^'illiam A. Boylston, '71, Coushatta. 

John E. Rooks, '05, Doyline. 

Lafayette Lake. '06. Louisiana State Insane 
Hospital, Jackson. 

William Buford Clark, '82, 1141 Baronne 
street. New Orleans. 



First Lieutenant William Benjamin Borden, 
M.D.. class of 1906. who has been a member of 
the Medical Reserve Corps for the past two years, 
on duty at Fort Bayard, N. M., has passed the 
preliminary examination for the Medical Corps 
of the Army. The examination was held at Fort 
Bayard, N. M., during the week beginning De- 
cember II. Dr. Borden was born in North Caro- 
lina in 1880. He has spent two years in a general 
hospital and one year in private practice before 
joining the medical department of the United 
States Army. He will be brought to the session 
of the Army Medical School, which begins Octo- 
ber I, 1912. Dr. Borden was under orders to sail 
for the Philippines on the January 5 transport, 
but on account of the short time he would remain 
in the Islands before it would be necessary for 
him to return to the States to come to the Army 
Medical School, this order has been revoked. 



Majors ^\'illiam N. Bispham. class of 1897. and 
\Mlliam F. Lewis, class of 1893. have been desig- 
nated to take the course at the Field Service 



2l6 



THE HOSPITAL BULLETIN 



School for Medical Officers at Fort Leavenworth, 
Kans.. for 1912. 



Lieutenant Benjamin H. Dorsey, Passed As- 
sistant Surgeon, U. S. N., class of 1901, is a guest 
in Baltimore at the present time. 



Dr. William Dodds Scott, Jr., class of 1904, of 
Cambridge, Md., and Dr. Frederick N. Nichols, 
class of 1902, of Denton were recent visitors in 
Baltimore. 



Dr. Charles Percy Noble, class of 1884, of 1509 
Locust street, Philadelphia, Pa., was born in 
Federalsburg, Md., November 15, 1863, son of 
William Davis and Mary Ann (Houston) Noble, 
and a descendant of American colonial ancestry. 
The first American Noble was John Noble, who 
settled in Somerset county in 1668, and received 
a grant of 500 acres of land from Charles Calvert, 
known as "William's Desire." Dr. Noble re- 
ceived his earlier education in the public schools 
of Federalsburg and Iowa Agricultural College. 
He then entered the University of Maryland, 
graduating in 1884. He immediately located in 
Philadelphia, serving for a time as first assistant 
and chief of clinic at Philadelphia Lying-in Char- 
ity Hospital, then surgeon-in-chief to Kensington 
Hospital for Women, then as gynecologist to 
Stetson Hospital, and clinical professor of g\ne- 
cology to the Woman's Medical College. 

Dr. Noble has written much for the medical 
press and several publications relating to diseases 
of women and abdominal surgery. He is coeditor 
with Dr. Howard A. Kelly of "A System of Gyn- 
ecology and Abdominal Surgery." He has been 
president of the Philadelphia Obstetrical Society 
and the Northern Medical .Society, and is a mem- 
ber of the British Gynecological Society, the 
.\merican Medical Association, the American 
G_\necological .Society, the Southern Surgical and 
Gynecological Society, and is a fellow of the Col- 
lege of Physicians of Philadelphia, besides hold- 
ing membership in numerous social clubs. He is 
an Episcopalian, a member of St. Mark's Prot- 
estant Episcopal Church. 

Dr. Noble married September 15, 1885, Miss 
Mira Rose of Newark, N. J. They have three 
children living — Charles Percy, Jr., Robert Hous- 
ton and Dorothy — and one — Eunice — deceased. 



The' committee in charge of the work of found- 
ing the Poe scholarship is meeting with such gen- 
erous and ready responses that they may be able 
to create two scholarships instead of one. Sub- 
scriptions have been received to date from Judge 
Henry Stockbridge of the Court of Appeals, 
Judges Henry D. Harlan and Walter I. Dawkins 
of the Baltimore Supreme Bench, Dr. Thomas 
Fell, president of .St. John's College, and Messrs. 
Joseph C. France, William L. Marbury, Eli 
Frank, .Mbert C. Ritchie, D. K. Este Fisher, 
Samuel Want, Edgar H. IVlcBride of Harvard, 
George Weems Williams, Bruner R. Anderson, 
Enoch Harlan, John Hinkley, Charles ( ). Laney 
of Dallas (Te.x.), Leon E. Greenbaum, George 
A. Solter, I. Augustine Mason of Hagerstown, 
Harry Welles Rusk, John D. Nock and Cxprian 
W. McSherry of Silver City, N. M. 

The committee in charge of the scholarship 
fund is composed of Cyril Hansel (chairman), 
Edgar H. McBride. Louis J. Jira, J. Stewart Glen, 
Charles H. Buck, George A. Rossing and Cyprian 
\\'. McSherrv. 



i\mongst our Mississippi alumni are : 
James A. Shackleford, 76, Greenville. 
Edward C. Coleman, '85, Kosciusko. 
Eugene C. Denson, '98, Meridian. 



Miss Elizabeth C. Patterson, L'niversity Ho.s- 
pital Training School for Nurses, class of 191 1, 
is assistant superintendent at the University 
Hospital. 



Dr. John Rawson Pennington, class of 1887, 
of Chicago, 111., is probably one of the best known 
of the University alumni. He was born in Cory- 
don, Ind., September 3, 1858. the son of Charles 
Peter and Rebecca (Conrad) Pennington. He 
gained his education in the public schools of 
Corydon, Corydon High School, the Indiana 
State Normal School and the National Normal 
School at Lebanon, Ohio. He entered the L^ni- 
versity of Maryland in 1884, graduating in 18S7. 
He served as an interne in the L'niversit)- Hos- 
pital during his last year there, and then became 
assistant to Dr. F. T. Miles in nervous diseases 
at the University. In 1889 he located in Louis- 
ville, Ky.. and became assistant to the chair of 
gynecology and obstetrics in the Kentucky school 



THE HOSPITAL BULLETIN 



217 



of Mediciiu-, and was rewarded in 1891 ] y the con- 
ferriii.s;- by that sehool of the degree of M.D. upon 
him. Me served there for two years as assist- 
ant to I^r. J. M. Matthews in rectal diseases, then 
resigned and went to St. Mark's Hospital in Lon- 
don, Kngland, to study fistula and other tliseases 
of the rectum, taking a special course in rectal 
surgery. In October, 1803. he returned to .\mer- 
ica, locating in Chicago, where he has attained an 
enviable position. He was for a time professor 
of rectal di.-eases in the Chicagti Clinical School, 
and resigned in IQOO to accept the chair of rectal 
surgery in the Chicago Polyclinical College. 

Dr. Pennington is a fellow of the American 
Proctologic Societ}', a member of the American 
Medical Association, Mississippi \'alley Medical 
Society. Illinois State Medical Society, Chicago 
Medical Society and the Physicians' Club of Chi- 
cago. He is a frequent contributor to medical 
literature and is standard authority on the sub- 
jects he treats. His contributions to International 
Clinics have attracted much attention. 



^liss Jennie R. Ciarner, University Hospital 
Training School for Nurses, class of 191 1, has 
been appointed superintendent of the maternity 
hospital of the University Hospital. 



Announcement was made at the White House 
on January 5 that President Taft had selected 
Dr. Rupert Lee Blue, class of 1892, to be Surgeon- 
General of the Public Health and Marine Hos- 
pital, succeeding the late Walter W^man. Dr. 
Blue was recently stationed at Honolulu and has 
been in the service since March 3, 1893. 



It is rumored that Dr. Robert Albert Warner, 
class of 1895, f^f 119 North Carey street, will be 
appointed superintendent of Sydenham Hospital, 
succeeding Dr. W'arren P. ^Morrill. Dr. Warner 
is a native of Baltimore, having been born here 
November i, 1871, the son of Luther F. and 
Josephine (Etchison) Warner. He gained his 
early education in the public schools of Baltimore, 
and then matriculated at the University of Mary- 
land, graduating in i8<)5. In 1904 he took a post- 
graduate course at the College of Physicians and 
Surgeons. He has served as clinical assistant at 
Bayview Hospital and as chief of clinic to Dr. 



John C. Hemmeter at the L'niversity Hospital. 
He married in 1900 Miss Carrie lirooks of Cov- 
ington, Ky. 



At the aimual meeting of the Ailjunct Faculty 
of the University of Maryland Dr. William 
Tarun, class of 1900, was elected president; Dr. 
E. H. Kloman, class of 1910, vice-president, and 
Dr. H. D. McCarty, class of 1905, secretary-treas- 
urer, to serve for the ensuing vcar. 



Dr. Walter S. Niblett, class of 191 1, has been 
appointed assistant resident physician to the 
James Lawrence Kernan Hospital and Industrial 
School for Crippled Children. 



Dr. William Henry Daniels, class of 1908, has 
been reappointed head of the dispensary of the 
James Lawrence Kernan Hosjjital and Industrial 
School for Crippled Cliildren at 2000 North 
Charles street. 



Dr. John Eugene ^McLaughlin, class of 1886. 
of Statesville, N. C, was Lorn near Statesville. 
October 4, 1862, the son of Gen. Richard A. 
McLaughlin and Mary J. (Murdock) AIcLaugh- 
lin, and is a descendant of Scotch- Irish ancestors. 
He was educated in the public schools, Statesville 
Male Academy and the University of Maryland. 
In 1900 he took a full course in the New York 
Post-Graduate Medical School. He began prac- 
tice in Cool Spring, N. C, in 1886, remaining 
there until 1900, when he removed to Statesville, 
where he has since resided. He diagnosed and 
successfully treated the first case of uncinariasis 
discovered in that part of the State. Dr. 
McLaughlin has been a member of the Iredell 
County Board of Health and professor of materia 
medica at the Statesville Training School for 
Nurses, of which he is vice-president. He is a 
member of the Iredell County Medical Society, 
the Iredell-Alexander Medical Society and the 
North Carolina State Medical Society. 

Dr. McLaughlin was married September 17, 
1890, to Miss Julia E. Murdock, and has two 
children — Edith M. and Esther B. McLaughlin. 



ENGAGEMENTS 

The engagement is announced of Miss Louise 
Irene Craig, University Training School for 



2l8 



THE HOSPITAL BULLETIN 



Nurses, class of 1903, to Mr. James Upshur Den- 
nis of Baltimore. The marriage will take place 
in Emanuel Chapel, Baltimore, Saturday, Janu- 
'ary 20, 1911. 



BIRTHS 



Dr. Walter W. White, class of 1896, and -Mrs. 
White (Leonore Doyle), University Hospital 
Training School for Nurses, class of 1906, have 
announced the hirth of a daughter, December 
II, 1911. 



Dr. Arthur Louis Fehsenfeld, clas^ of 1909, 
and Mrs. h'chsenfeld. Garrison and Fairvicw ave- 
nues. Forest Park, announce the birth of a son 
in December. 



MARRIAGES 



Miss Emclia .-Vugusta Strohm, University Hos- 
pital Training School for Nurses, class of 1910, 
was married in September, 191 1, to Mr. W. G. 
Spalding of Brooklyn, N. Y. 



Miss Martha \"enable Edmunds, University 
Hospital Training School for Nurses, class of 
1910, was married in October, 191 1. to Dr. 
Dwight Gray Rivers, class of 1910. They are 
living at Fort ^\'hite, Florida. 



Mrs. E. B. Walls has announced the marriage 
of her daughter. Miss Clara Elizabeth Walls, to 
Dr. Norman Spear Dudley, class of 1901, on 
Thursday, December 21. 1911, at Wilmington, 
Del. Thev are residing at Church Hill, Md. 



Dr. John llenr\- \'on Dreele. class of 191 1, was 
married on Wednesday, December 27, 191 1, to 
Miss Marvel E. Scarfl', daughter of Mr. and Mr^. 
William E. Scarff of Sharon, Md. The ceremony 
was performed at the parsonage of Grace M. E. 
Church, Baltimore, by the pastor. Rev. Air. Beale. 
Miss Scarff is a graduate of the University Hos- 
pital Training School for Nurses, class of 191 1. 
Dr. \'on Dreele is also a graduate of the School 
of Pharmacy of the L'niversity, class of 1904. 
He served for one year as resident physician at 
the Alunicipal Hospital, Baltimore. The couple 
will reside at 846 West 3(^111 street. Baltimore. 



DEATHS 

Dr. Enoch tjeorge, class of 1872, died at his 
home in Denton, Caroline county, Maryland, Jan- 
uary 12, 1912, of pneumonia. 

Dr. George was born in .Sudlersville, Queen 
Anne's county, Maryland, June 30, 1850, the son 
of Dr. Enoch George, who died in 1858, and 
Catherine Boone George, and the grandson of 
Enoch George, a distinguished divine of the Prot- 
estant Episcopal Church and the fifth bishop of 
that church in .-\merica. Dr. George was edu- 
cated in the public schools of Denton, Fort Ed- 
ward Collegiate fnstitute at Fort Edward, New 
York, and later at a business college in Phila- 
delphia, Pa. In October, 1870, he entered the 
medical department of the University of Mary- 
land, graduating in 1872. He was an interne at 
the L^niversity Hospital during his senior year, 
and after graduation began practice at once in 
Denton, Md., where he remained until his death. 
He was for many years president of the Caroline 
County Medical Society. He was a member for 
scA-eral years and at one time president of the 
Caroline County Board of Education, and has 
served as county health officer, member and sec- 
retary of the Board of Health of the county, and 
also president and member of the Board of Town 
Commissioners of the town of Denton. He was 
elected a member of the Medical and Chirurgical 
Faculty of Maryland in 1891. Dr. George was 
well known in Caroline politics as a Democrat. 

Dr. George married Aliss Eva M. Horsey of 
.Maryland, who survives him. He leaves two 
sons — Enoch George, Jr., and Dawson Orme 
(jeorge, a studen.t in the Medical School of the 
L'niversity of Maryland, class of 1912. 



Dr. William Constantine Pease Boone, class of 
1872, of I'lainfield. X. J., died on December 30, 
191 1, aged 67 years. Dr. Boone was born in 
Washington, D. C, April 16. 1844, the son of 
John Francis and Louise .Anna Afaria (Baker) 
]^)Oone. His parents were both of old Maryland 
stock. He received his primary education at 
W'ashington Seminary (now Gonzaga College), 
Washington, D. C. He entered Georgetown Uni- 
versit\-, but left his studies while in the junior 
_\ear to enlist as a private in the Confederate 
Army, Company E, First Regiment Maryland 
Cavalrv, and served throughout the entire war 



THE HOSPITAL BULLETIN 



219 



between the States. After peace was restored 
he studied medicine under tlie private tutelage 
of Prof. Ricliard AlcSherry, then entered the Uni- 
versity of Maryland, graduating in 1872. 

Me located in Plainfiekh where he remained 
until his death. He was attending physician on 
the medical stafT of Muhlenberg Hospital. Plain- 
lield, for many years, and at the time of his death 
a director of the institution. He was also physi- 
cian to several fraternal orders. 

Dr. Txione married on April 11, 1872, Aliss 
Annie Maria Hering of New York, who survives 
him. He also leaves a brother, Rev. Edw'ard D. 
Lloone of Loyola College, iJaltimore, and three 
sons, Rev. Charles E. Boone of St. Mary's Semi- 
narv, Messrs. William .Arthur and Juhn Francis 
P)Oone, and two daughters. Misses .\nne and Car- 
oline Edith lioone. 



of his profession in what he nobly conceived to be 
his line of dutv." 



Few things have more profoundly shocked the 
community of Rockingham county, \"irginia, than 
the death of Dr. Joseph V. Milton, class of 1901, 
in Harrisonburg, \'a., on December 16, 191 1, of 
])neumonia. Dr. Joseph Vandevanter Milton 
was a son of the late Theodore Davisson Alilton 
and Mrs. Lydia C. Milton, and was born near 
Lacey Spring, \'a., 35 years ago. He studied at 
the Danville Military College and later matricu- 
lated at the University of Maryland. He spent 
some time in a hospital after his graduation, and 
then located in Lacey Spring, going into a part- 
nership with Dr. Thomas F. Keen, class of 1880. 
In 1907 he was married to Miss Anne Page 
Maury of New York, who survives him. He also 
leaves his mother, five sisters and one brother. 
He was buried in Lakeview Cemetery, from St. 
Paul's Protestant Episcopal Church, with an es- 
cort of Masons from Hamilton Lodge, of which 
he was a past master. The active pallbearers 
were three of his brother-physicians — Drs. Thos. 
F. Keene, class of 1880; John Aklridge Gibson, 
class of 1901, of Leesburg, \'a., and Albert Bra- 
den — and Messrs. A. C. \'andevanter, F. N. Kerr 
and G. Ernest Leith. 

Dr. Milton was loved by all who knew him, and 
the most touching tributes have been paid to his 
memory by those among whom he labored. Many 
of his friends believe he incurred the attack of 
pneumonia from which he died in attending to his 
professional duties, and as one of the local papers 
expresses it, "it is generally conceded he simply 
sacrificed his voung life to the exacting demands 



Dr. Summerfield Berry Bond, class of 1883, 
died at his home in Baltimore December 21, 191 1, 
aged 50 years, after a lingering illness. 

Dr. Bond was born in Ijaltinmre .\pril 9, 1861, 
the son of Hugh Lennox and Annie G. Penniman 
Bond, and comes of American-English ancestry. 
1 lis literar_\- education was gained in private acad- 
emies and Phillips E.xeter .\cademy in New 
Hampshire, and later in study in Europe. He 
graduated from the Medical School of the Uni- 
versity in 1883, and took post-graduate courses 
in the Johns Hopkins University and Paris. He 
was chief of clinic to the professor of surgery in 
the University of Maryland from 1884 to 1886, 
and for a number of years clinical professor of 
genito-urinary diseases ; then w^as for some years 
medical examiner to the Pennsylvania Railroad, 
and was located in Pennsylvania. During his stay 
in that State he married Miss Julia Valentine. 
I'^or the past 10 years he was surgeon to the Bal- 
timore & Ohio Railroad, and chief medical exam- 
iner of their relief department. 

He is survived by his widow and two children, 
]\Iisses Lydia Valentine and Julia Valentine Bond. 
The funeral was held from Emanuel Protestant 
Episcopal Church, Baltimore, on Sunday, Decem- 
ber 24, 191 1. 

"A true friend of young men" was the title 
which Dr. Bond bore in medical circles in this city. 
This was due to his willingness to help students 
at the University and young physicians whose 
capital did not enable them to withstand the 
"lean" years of early practice. 

He was essentially a worker in his chosen field, 
although he was much attached to his home. He 
was little identified with the social life of the city, 
preferring to read in the company of his family 
and to chat occasionally with intimate friends at 
the University Club, of which he had been a mem- 
ber for a long time. 

Fishing and sailing were his principal diver- 
sions, but, particularly after he become connected 
with the railroad company, he took only short 
vacations and contented himself with cruises 
down the ba}'. 

Dr. St. Clair Spruill said of him : 

"It is safe to say that Dr. Bond had more 
friends in the medical profession in Baltimore 
than any other man in that fraternitv. He was 



220 



THE HOSPITAL BULLETIN 



lovable, principally because of bis sympathy for 
the downtrodden. His benefactions were accom- 
plished with little fuss, but there are many here to 
testify to them." 



BOOK REVIEWS 

Intern ATioN.\L Clinics. A Quarterly of Illus- 
trated Clinical Lectures and Especially-Pre- 
pared Original Articles on Treatment, Med- 
icine. Surgery, Neurology, Pediatrics, Ob- 
stetrics. Gynecology, Orthopedics, Pathol- 
ogy, Dermatology, Ophthalmology, Otology, 
Rhinology, Laryngology, Hygiene and Other 
Topics of Interest to Students and Practi- 
tioners. By Leading Members of the Medical 
Profession Throughout the World. Edited 
by Henry \V. Cattell. A.M., ]\I.D.. Philadel- 
phia, L". S. A. \'olume I\'. Twent\-first 
series. 191 1. Philadelphia and London: J. 
B. Lippincott Company. Cloth, $2 net. 
Some of the articles of this volume and their 
authors are : "Enuresis : With Special Reference 
to Its Causation and Treatment." James Burnett. 
M.A., :\I.D., M.R.C.P. (Edin.), registrar Royal 
Hospital for Sick Children, examiner in materia 
medica to the University of Aberdeen, etc. : "Pro- 
[ihylactic Treatment of Hypertrophy of the Pros- 
tate Gland, with Remarks on an Efficient Method 
of Treating Acute Gonorrhea," Edgar G. Bal- 
lenger, ?\I.D., and Omar F. Elder. M.D., Atlanta, 
Ga. ; "Agar-Agar in the Treatment of Constipa- 
tion and Diarrhoea," Dudley Roberts. M.D.. at- 
tending gastro-enterologist, Brooklyn Hospital, 
etc. : "The Modern Treatment of Syphilis." Wm. 
R. Trimble, M.D., lecturer on diseases of the skin, 
New York University (University and Bellevue), 
etc. ; '"Senile Mentality," I. L. Nascher, M.D., spe- 
ciaT lecturer in geriatrics, Fordham University, 
School of JNIedicine : "Modern Instruments of 
Precision in the Study of Cardiovascular Dis- 
ease," George William Xorris. A.B., M.D., as- 
sistant professor of medicine in the University 
of Pennsylvania, etc.; "Rat-Bite Disease, with 
Report of a New Case," Frederick Proescher, 
M.D., Pittsburgh, Pa. ; "The Operation for the 
Radical Cure of Inguinal Hernia with Local An- 
esthesia." J. A. MacMillan, M.D., Detroit, Mich. ; 
"The Rational Treatment of Catarrhal Deafness 
and Tinnitus," Harold Hays, A.M., M.D., assist- 
ant surgeon in otology, New York Eye and Ear 
Inrtrmar\-, etc. : "Legal Facts a Phvsician Should 



Know in Surgical Cases," George K. Frink, M.D.. 
San Francisco, Cal. ; "The Successful Practice of 
Medicine," Thomas F. Reilly. professor of ap- 
plied therapeutics. Medical Department, Fordham 
University, New York city. 

It gives us pleasure to call attention to the ar- 
ticle on "Prophylaxis of Prostatic Hypertrophy," 
by Edgar G. Ballenger, class of 1901. Dr. Bal- 
lenger, since graduating, has specialized in genito- 
urinary diseases, in which specialty he has at- 
tained marked distinction and success. As noted 
above, the contributions cover practically every 
aspect of medical endeavor. The volume will be 
found a veritable encyclopedia by general prac- 
titioners who desire to keep abreast of medical 
advances. 



LABORATORY REPORT OF THE UNI- 
VERSITY HOSPITAL. 

Months of October and Novemeer. 

Blood Exaiiiinatioiis. 

Oct. Nov. 

Leucocytes Counts 220 228 

Erythrocytes Counts 60 72 

Differential Leucocyte Counts 22 28 

Hemoglobin Determinations 88 92 

Coag. Times 2 3 

Smears for Malarial Parasites 30 36 

r>lood Cultures 8 10 

Widal Tests 62 60 

Wasserman Tests 31 40 

Urine Examinations. 

Routine Urinalysis (chemical and 

microscopic) 342 380 

Total Estimations for Urea 17 25 

Total Estimations for Urea in Blood. 12 18 

Miscellaneous. 

Gastric Contents (chemical and mi- 
croscopic) 14 18 

Feces (microscopic, etc.) 11 19 

Sputum Examinations 20 24 

Bacterial Cultures and Smears 26 32 

\accines 5 7 

.Spinal Fluid E.xaminations 3 5 

Sections of Tissue for Microscojjic 

Examination 18 20 

.Autopsies 2 3 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department o£ the University of Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VII 



BALTIMORE, MD., FEBRUARY IS, 1912. 



No. 12 



SEE AMERICA EIRST. 



By Randolph Winsi.ow. 



6. S.\LT LAKE CITY. KOVAL GORGE. COLORADO 

SPRINGS, pike's PEAK. GARDEN OF THE 

GODS. HACK TO THE EFFETE EAST. 

Salt Lake City is not situated on the Great Salt 
Lake, but is about 16 miles from that inland sea. 
It has made great improvements since my visit in 
1905. Its streets have been paved with smooth 
pavements, and many fine new edifices have been 
erected : nevertheless, the air of mystery still en- 
velops it, and one feels very much as if he was in 
a foreign land. It is the capital of Mormondom 
and derives its chief interest and importatice from 
that fact. Brigham Young was a long-headed 
and wise man when he selected this pleasant val- 
ley as the site of his city of Zion, with its peren- 
nial stream of cool mountain water, which he 
called the River Jordan. Protected on the east 



by the Wasatch Mountains, and with a body of 
salt water 2500 square miles in area on the west, 
the extremes of heat and cold are almost never 
experienced, while one can enjoy the pleasures of 
salt-water bathing, on the one hand, or the invig- 
orating mountain air, on the other, by traveling 
only a few miles in either direction. The Mor- 
mons were fond of likening themselves to the 
Israelites in patriarchal days, and in many re- 
spects adopted the same customs. Thus polyg- 
amy became one of their most cherished tenets, 
which has only lately been publicly discontinued, 
though many of the saints still have several wives. 
Joseph F. Smith, the President of the Church at 
this time, has five wives and numerous children. 
Brigham must have been a fine judge of women 
as well as of land, as he is reputed to have had 
19 wives, some of whom had separate houses, 
while others lived in communal establishments. 
We asked a sour-visaged woman of uncertain age, 
who was employed at the Bureau of Infomiation, 




GENUINE AMERICANS, 1911. 



222 



THE HOSPITAL BULLETIN 



how many wives President Young had. She re- 
plied in acidulous tones that she had never in- 
quired ; it was the man's business as to how many 
wives he should possess, and did not concern any- 
one else. In the center of the city is the Temple 
enclosure, lo acres in extent, in which are the 
Temple, to which only the very elect are admitted : 
the Tabernacle, which is open to the public, and 
the Assembly Hall. The Temple is a tall, some- 
what Gothic-looking structure of light granite, 
which was 40 years in building, and in which the 
most sacred and secret rites of the church are 
performed. The Tabernacle is an enormous and 
wonderful structure, capable of seating 10,000 
persons. It is elliptical in shape, and may be lik- 
ened to a prodigious eggshell cut lengthwise and 



Christian churches. The music and singing of 
the immense choir was magnificent and inspiring, 
but the address that followed was a tedious re- 
cital of the great virtues of the Latter-Day Saints, 
which was intended to impress the Gentiles pres- 
ent rather than to edify the elect. 

Saltair Pavilion is situated on the Great Salt 
Lake, and is a miniature Coney Island. Plere 
one can enjoy the salt-water bathing, which, how- 
ever, differs very much from that at any seaside 
resort, as the water is 22 per cent, salt and one 
cannot sink in it. \\'hile one cannot sink in the 
Salt Lake, he can very easily be drowned, as it is 
very difficult to right onself if by chance he gets 
his face turned downwards in the water. After 
bathing, like Lot's wife, he or she is converted 




TE-Mrr.E .\XI) T.\BEItN.\( I.E. SALT I>.\KE CITY, UT.VII 



placed on pillars. It is 250 feet in length, 150 feet 
wide and 70 feet in height from the floor to the 
ceiling. It has no central supports, but makes a 
sheer arch from side to side. The sides of the 
building between the pillars are doors that can be 
thrown open at a moment's notice and the edifice 
completely emptied almost at once. The acoustic 
properties of this building are probably unetjualed 
in the whole world, as the dropping of a pin or 
the rustling of a paper can be distinctly heard 
the whole length of the auditorium. The organ 
is also one of the marvels of music, and can be 
made to imitate the human voice almost perfectly. 
We attended service here on Sunday, A prayer 
was offered by an official that might equally as 
well have been made by a Methodist or Quaker 
preacher. It differed in no manner from the in- 
vocations that one is likely to hear in any of the 



into a pillar of salt, and requires a bath in fresh 
water to resume his normal appearance. The 
manufacture of salt from the water of the lake is 
a large industry, and is accomplished by piping 
the water to ponds, where it is allowed to evap- 
orate, after which it is purified and is ready for 
use. While passing along a street we noticed the 
sign Chesapeake Ivestaurant, and on entering 
found the walls lined with pictures representing 
aquatic life and sports on the Chesapeake Bay. 
Incidentally we found the meals excellent and the 
prices reasonable. 

Leaving Salt Lake City by the Denver & Rio 
Grande Railroad in the afternoon, we pass 
through a number of towns of no especial at- 
tractiveness, at which men and women, also not 
attractive in appearance, were, to be seen, and 
thence traverse Eastern Utah in the night, our 



THE HOSPITAL BULLETIN 



2^3 



destination being Colorado Spriii.sjs. Early in the 
morning we are in Colorado, and our route is 
through the Canyon of the Grand River, whicli 
is a narrow defile through precipitous mountain 
walls 2500 feet in height. These rocks are of 
many colors, the reds being especially vivid and 
striking. Past Glenwoods Springs, through the 
Canyon of the Eagle River, which not only pre- 
sents the peculiar coloring and characteristics 
just described, but the curious sight of mines be- 
ing worked up and down the face of the perpen- 
dicular cliffs, we ascend the mountains and cross 
the continental divide at an elevation of 10,200 
feet. Leadville is seen perched on the mountain 
top, and is said to be the highest modern city in 
the world. We are now on the eastern slope of 



ing in rainless regions, but at Colorado Springs 
a sudden and torrential downpour overtook us, 
much to the delight of an old lady from the East, 
who piously gave thanks that she was permitted 
to see the rain descend again. Manitou is five 
miles from Colorado Springs, and is itself a re- 
sort of note, with its springs of soda and iron, its 
Cave of Winds, Garden of the Gods and many 
other attractions, h'rom here the cogwheel rail- 
road runs to the summit of Pike's Peak, nine 
miles distant. Pike's Peak is a wonderful natural 
monument, 14,147 feet in altitude, and standing 
out boldly, so that it may be seen for a great dis- 
tance. It may lie ascended on foot by those who 
like that form of travel ; on mules, which is pref- 
erable, and by the railroad, which is the easiest. 




[.VNOIXC BRirMJE IX THE R0Y,\Ij (;0R<!E. C0L0I!.\r)0. 



the Rockies, and all the streams flow into the 
Atlantic Ocean. W-e follow the Arkansas River, 
which rushes madly downwards through narrow 
rock-ribbed walls, until at the Royal Gorge the 
cleft in the mountains is but 30 feet wide, and the 
train crosses on a hanging bridge that springs 
from the rocks on each side. The stars can be 
seen at noonday, and the sky is only a thread of 
blue seen through the gap a half mile up in the 
air. 

Pueblo, a very busy town and the second in pop- 
ulation in the State, is passed, and not long there- 
after Colorado Springs is reached. This is a 
famous health resort, and is beautifully situated 
in the valley, with Pike's Peak raising his lofty 
head in the near distance. The Antler's Hotel is 
a splendid establishment and is a favorite resort. 
For a month we had been traveling and sojourn- 



quickest and most comfortable way for a tender- 
foot like tile writer. The ascent takes about an 
hour and a half, and the route is beautiful and 
picturesque. Plunging almost at once into a nar- 
row defile, the train ascends rapidly up a very 
steep grade, at times as much as 25 per cent. The 
mountain sides are heavily wooded, and riotous 
streams rush rapidly down. Here and there are 
rustic hotels, cottages or camps, where people 
were enjoying the open and free life of the high- 
lands. Wide vistas open at times and permit 
views of snow-capped mountains and valleys 
clothed with beautiful verdure and sparkling with 
variegated flowers. At about 11,000 feet eleva- 
tion the timber line is reached, and above this 
there are no trees, but extensive plateaus, on 
which only grass and hardy flowers grow. Still 
ascending, the engine groans, as if in mortal ag- 



224 



THE HOSPITAL BULLETIN 



ony, as it labors, like Sisyphus, to push its load up 
the everlasting' hill. The air becomes not only 
chilly, but rarified, and some people are oppressed 
and even overcome by the altitude. The writer 
only experienced some increased frequency in 
respiration and in the pulse rate, but no actual 
distress. Above 12,000 feet all vegetation ceases, 
and the top of the mountain is a mass of broken 
rock. The summit is a rounded, domelike apex, 
absolutely bare except when covered with snow, 
upon which is a small hotel and observatory for 
the accommodation of those who wish to spend 
the night in order to see the sunrise. From the 
summit probably the most magnificent view in the 
whole world is to be enjoyed if the day is clear. 
One is forcibly reminded of the incident recorded 
in Matthew, chapter iv, verse 8, where "the devil 
taketh Him up into an exceeding high mountain, 
and showeth Him all the kingdoms of the world 
and the glory of them." From this lofty eyrie 
the view is bounded only by the limitations of hu- 
man vision. Almost the whole State of Colorado 
is spread, as a map, before the spectator, and Col- 
orado Springs and other cities are seen as huge 
checkerboards in the distance. On the summit 
itself is the lonely grave of a young girl, with the 
inscription, "Eaten by mountain rats." What 
either the girl or the rats were doing up there is 
not mentioned. Certainly, there was nothing else 
there that the rats could eat. At the time of our 
visit the summit was free from snow, .and the 
temperature was not disagreeably cold, though 
light overcoats were very comfortable. As has 
been stated, the timber line is reached at about 
ii,DOO feet, and above this many colored flowers 
grow in profusion. At this elevation a pretty 
young girl boards the train and offers posies of 
Pike's Peak forget-me-nots for sale, which were 
both beautiful and fragrant. The drinking water 
of Colorado Si)rings is derived from this moun- 
tain, and there are successive reservoirs for col- 
lecting and distributing the water almost to the 
top of the Peak. Certainly, there could scarcely 
be a watershed less exposed to contamination than 
this. Half way up the mountain is a printing 
office, where a daily paper is issued, which does 
not give a large amount of space to the foreign 
or domestic news, but does contain an accurate 
list of the names of those who make the ascent 
each day, with items of interest in regard to the 
incidents of daily travel. Descending at about 
1.30 P. M., a goixl meal mav be obtained at the 



station, and carriages may be taken for a drive 
to the Cave of ^\'inds, the Garden of the Gods 
and other points of interest. The Cave of the 
Winds is said to he well worth a visit, but time 
did not allow us to take it in ; instead we went 
to the Cliff' Dwellings and the Garden of the 
Gods. The Cliff' Dwellings are not located on 
their original site, but have been transplanted 
from Southwestern Colorado to their present 
location, where they have been reconstructed, 
stone vipon stone. They are very interesting 
relics and give one an accurate idea of the mode 
of life of these wary tribes, who, like the conies, 
were but a feeble folk, yet they made their houses 
in the rocks. Nearby is a pueblo of recent con- 
struction, inhabited by Indians, who give exhibi- 
tions, as well as manufacture their wares for 
sale. For a few coins we were favored with a 
doleful dance, accompanied with a nerve-racking 
chant. The Garden of the (iods is a barren and 
picturesque tract of hill and dale, with many curi- 
ously-fashioned rocks, grotesquely resembling 
figures of animals, people and buildings. These 
rocks are of reddish color, and have been eroded 
bv wind and storm until some of them arc bal- 




r..vL.v.Nrio unrK. i,aiu'i;-\ ni' rm; i_:ol>s, 

MANITOU, COLORADO. 



THE HOSPITAL BULLETIN 



225 




SUMMIT OF PIKK-S PEAK, COLORADO. 



aiiced almost on a pivot, and look as if a puft of 
wind would blow them over. 

A side trip of wonderful interest, which, how- 
ever, I was not able to lake, is to Cripple Creek, 
said to be the greatest gold-mining region in the 
world. The railroad goes boldly up and over the 
lofty mountains, and is of marvelous scenic 
beauty. 

Leaving Colorado Springs on ]u\x 18, we took 
leave of sight-seeing and struck out for home, 
reaching Denver about 8 o'clock in the evening, 
and remaining only long enough to get a good 
dinner at a hotel near the station. Denver was 
brilliantly illuminated with electric lights and 
signs, probablv on account of some convention 
that had been or was being held there. The next 
morning we were rurming through the rolling, 
highly-cultivated prairies of Xe'^raska, and 
reached Omaha in the afternoon. Having some 
time to spare, we took a ride into the city, which 
in a short and superficial inspection did not ap- 
pear to be a very attractive place. Crossing the 
Missouri River on a high bridge, we passed 
through Council Bluffs and thence across the 
State of Iowa to Chicago. I had never been in 
Iowa before, and was agreeably surprised at the 
appearance of the country, which was attractive, 
with trees and w-ater in abundance and the fields 
in a high state of cultivation. We reached Chi- 
cago early on the 20th, and took a Lake Shore 
train for New York. We were now in the de- 
cadent and eflfete East and were on more familiar 
ground, passing through Toledo, Sandusky, 
Cleveland, Euflfalo and other cities on the shore 
of Lake Erie; thence through Syracuse and 
L'tica, and along the line of the new Erie Canal, 



which is in the course of construction, to Albany; 
down the Hudson to New York, and a rapid 
transfer from the Grand Central to the new 
Pennsylvania Station, where we caught a fast 
train to a little, old, slow town called Baltimore, 
which we reached at 9.30 P. M. on July 21 after 
a trip crowded with delightful, interesting and 
instructive incidents and covering about 10,000 
miles of the earth's surface. 

As we came down from New York there were 
no hoary mountains in sight, but the grass was 
green, the lawns well kept and the homes pleasant 
to look upon, and when we passed Philadelphia 
and came to the splendid rivers of Maryland I 
was satisfied to remain in a land that is some- 
times hot in summer and cold in winter, but, 
taken the year around, is veritably a land flowing 
with milk and honey. It is said that an Icelander 
when he returns to his native island exclaims : 
"After all, Iceland is the best country that the 
sun shines upon," and in the same spirit the trav- 
eler returning to the shores of the Chesapeake 
devoutly says, "Maryland, my Maryland !" 



HYPEREMESIS GRAVIDARUM AND 
NEURITIS PUERPERALIS RESULT- 
ING AS A SEQUELA OR COMPLI- 
CATION, WITH REPORT OF A CASE. 



By Edward Sooy Johnson, 
Senior Medical Student. 



Probably the commonest disorder of the digest- 
ive tract seen in pregnant and puerperal women 
is vomiting, occurring in one-third of all cases 
of pregnancy. This type of gastric disturbance 



226 



THE HOSPITAL BULLETIN 



is divided into two great classes: (a) physiologi- 
cal or simple vomiting; (b) pathological or per- 
nicious vomiting. 

Simple vomiting of pregnancy is usually pres- 
ent during the earlier months, and ceases at the 
end of the fifth month. While causing distress, 
and ofttimes much discomfort, it does not se- 
riously impair the nutrition of the pregnant 
woman ; in fact, some multiparse v^-omen have 
become so accustomed to it that they have learned 
to look upon it as a natural sequence during their 
respective pregnancies. 

Pernicious vomiting, on the other hand, is a 
very serious condition, which may, if it resists 
treatment, place the woman's life in jeopardy. 
There are three chief divisions: (a) neurotic, 
(b) reflex, (c) toxemic. 

Etiology. — The etiology of pernicious vomit- 
ing is indeed obscure. So many factors may con- 
tribute to the production of this condition that 
just what is the cause can rarely be stated. 

Giles has pointed out that probably three fac- 
tors enter into the predisposing causation of the 
vomiting of pregnancy, namely, (i) exalted 
nerve tension, (2) peripheral nervous irritation 
arising from the enlarged uterus, (3) an easy 
outlet of the exalted tension, namely, the vagus 
nerve. 

By the exaggeration of any one or two of these 
factors pernicious vomiting may be produced. 

Bearing these three factors in mind, the pre- 
disposing causes of pernicious vomiting may be 
summed up as follows : 

(a) In primipara the distention of the uterus 
is accomplished with much greater difficulty, on 
account of the greater tonicity of the uterine mus- 
cular fibers. 

(b) Pre-existing or co-existing diseases of the 
uterus, as metritis, endo-metritis and cervicitis ; 
also such abnormalities as. twin pregnancies and 
bydramnios. 

(c) Diseases of other pelvic organs, as salpin- 
gitis, ovaritis or inflammation and engorgement 
of neighboring organs or structures, the liver, 
kidneys and brain being the most important sites. 

(d) Pathological state of the alimentary canal, 
as gastric ulcer, dyspepsia, gastritis, etc., acting 
directly upon and increasing the latent stimulat- 
ing forces of the sympathetic nervous endings in 
the stomach. 

(e) Too frequent sexual intercourse. 

(f) Hysteria, mental or physical shock. 



(g) General distxirbance in metabolism and 
toxic conditions of the circulating tissues of the 
body, such as uremia and sapremia, etc. 

Probably the most important exciting cause of 
nausea and vomiting in pregnant women is phy- 
siological uterine contractions. The nerve sup- 
ply of the uterus is chiefly derived from the 
ovarian and hypogastric plexuses of the sympa- 
thetic nervous system, which to a certain extent 
has an independent action, while in the medulla 
there is a center which presides over uterine con- 
tractions. 

It is a well-known fact that the uterus is sub- 
ject . to rhythmical contractions throughout the 
whole period of pregnancy, and it is probable that 
the purpose of these contractions is to facilitate 
the circulation of blood through the uterine 
sinuses. 

The enormous distention of the veins of the 
uterus which occurs as the result of pregnancy 
brings about a retardation of blood in the sinuses, 
and when the contraction of the uterine muscula- 
ture begins, most all the blood is driven out, and 
thus the uterus may be said to supplement the 
action of the heart, to which it may, in a sense, 
be compared, since the nervous supply is also 
very similar in arrangement. 

It must be admitted that in the development 
of the embryo and the marked changes that the 
uterus undergoes at this same time, many chemical 
changes must occur. It is from the venous si- 
nuses at the placental site that the embryo derives 
its chief nourishment, and into which the residue 
(or ashes, as it were) are emptied. 

Ordinarily, the circulation of the blood through 
the sinuses provides for the change in supply, 
but owing to the slowing of the blood current 
from dilatation of the sinuses, there may be a cer- 
tain residuum, and as the blood becomes sur- 
charged with this they probably act as irritants 
to the sympathetic nerve endings and stimulate 
the uterus to contractions, and thus to a certain 
e.xtent the uterus may be said to empty itself. 

It is these contractions, so brought about, which 
probably cause the paroxysms of nausea and 
vomiting. It is also probable that the nausea and 
vomiting which occur in 90 per cent, of cases in 
the morning is due to the engorgement of the 
pelvic circulation consequent to the change in 
posture. This change leads to excessive uterine 
contraction, and thus the peripheral irritation is 
increased. Now, if the patient partakes of a lit- 



THE HOSPITAL BULLETIN 



227 



tie food before arising', a certain amount of this 
blood is retained in tlic stomach to carry on di- 
gestion, which might otherwise go to the pelvic 
area and suliseqnently be sufficient to cause the 
vomiting. 

All of the above can only be classed as predis- 
posing to pernicious vomiting, and the exact ex- 
citinsj cause of this dreaded disease is yet to be 
found. 

Syniptotiis. — Ordinarily, pernicious vomiting 
begins as a simple nausea and vomiting of preg- 
nancy, which gradually becomes so frequent and 
severe that nothing can be retained on the 
woman's stomach. 

As stated above, \\'illiams gives three distinct 
types, as follows — (i) neurotic, (2) reflex, (3) 
toxemicT— with which we have to deal, and, un- 
fortunately, the mere severity of the symptoms 
gives no clue as to the particular variety with 
which we have to deal. 

In the reflex and neurotic types, the vomiting 
may continue for many weeks, and the patient 
becomes more and more emaciated, and finally 
dies of starvation if suitable treatment is not in- 
stitutetl. 

In the toxemic variety, similar symptoms may 
exist for some time, and the true condition may 
not be recognized until the patient begins to 
vomit coffee-ground-like material, which she 
ejects in enormous quantities with but little or no 
apparent effort on her part. 

Jaundice may or may not appear: the urine 
usually becomes greatly diminished in amount, 
and frequently shows albumin and casts in large 
numbers, though the latter (casts) in many cases 
are entirely absent. The urine frequently con- 
tains large quantities of blood, usually in the form 
of hematin crystals. 

It was formerly taught that the temperature 
and pulse is always accelerated, but this is not the 
case, since the pulse has been frequently seen be- 
low 90 per minute and temperature subnormal. 

The duration of pernicious vomiting is usually 
from two to three months, the nutrition gradu- 
ally becoming poorer and poorer. Finally the 
patient dies of starvation. 

Exceptionally the disease takes on a very rapid 
course, and after only a few days of ordinary 
vomiting the patient begins to eject blood-stained 
material and passes into a comatose condition and 
dies within a few days without any marked 
emaciation. In such cases death is evidently due 
to acute toxemia, and not to starvation. 



Pathology. — Neurotic form : no cause found in 
urinalysis, and no pathological changes either 
found macroscopically or microscopically any- 
where. 

Reflex form : no pathological changes foimd in 
any organ, but investigation may reveal a tumor 
or other tissue formation sufficient to produce the 
nervous train of symptoms. 

Toxemic form : largely determined by urinary 
analysis. The methods are very complicated, and 
often misleading and unsatisfactory. We also 
find, post-mortem, fatty degeneration of various 
organs and structures, the liver, kidneys and 
i)rain tissue being the principal structures in- 
volved. 

Diagnosis. — Between neurotic and toxemic is 
1/y exclusion and by urinalysis. Between tox- 
emic form and other forms is also by exclusion 
and urinary findings, amount of ammonia in re- 
lation to that of nitrogen being most important, 
normal ammonia coefficient being 4 per cent, to 5 
per cent., and in toxemia of pregnancy we may 
have an increase of from 5 per cent, to 50 per 
cent. ; 10 per cent, may be considered positive of 
toxemia. 

Prognosis. — Good in reflex and neurotic types, 
]iut very grave in the toxemic form, the mortal- 
ity being from 40 per cent, to 60 per cent, in all 
non-operated cases and from 20 per cent, to 30 
]ier cent, in cases treated by the induction of abor- 
tion. 

Pernicious vomiting occurs once possibh' in 
every 800 cases of pregnancy, 80 per cent, of this 
number being primiparse above the age of 25 
years. 

Trcatnieut. — (i) Prophylactic, (2) dietetic, 
(3) curative. 

Prophylactic : Restricted diet for two or three 
days at onset of any abnormal symptoms of di- 
gestive tract. Give liquid food by mouth or rec- 
tum. (2) Cut short intake of nitrogenous foods, 
meats, etc. (3) High blood pressure reduced if 
it exists. (4) Elimination by skin, bowels, etc., is 
very important. (5) In short, close observation 
by a competent physician during the pregnant 
state will reduce the mortality more than any 
other one thing. 

Dietetic: Give one glass of milk even,^ four 
hours with same amount of water, alternating each 
two hours. (2) If patient cannot take milk, give 
oysters, fish, green vegetables, rice (boiled). (3) 
At times vou mav substitute buttermilk, various 



228 



THE HOSPITAL BULLETIN 



prepared milks and milk ^\■ith certain effeyerscing 
waters. 

Curative : ( i ) Diaphoretic water, potass, 
acetate in oii doses t. i. d. (2) diuretics, saline 
purgatives, hot baths, etc. (3) Hemmeter recom- 
mends the following prescription: B. — Cerium 
oxalate, gr. xv; cocaine muriate, gr. iii; menthol, 
gr. xii : bis. subnit.. oi : simple elix. q. s. ad. .^vi. 
Sig. : jss on empty stomach four times a day. 
(4) If above treatment fails and woman con- 
tinues to get worse, induce labor at once. 

Complicating and following hyperemesis gravi- 
darum in a certain number of cases there develops 
a multiple neuritis with varying degrees of se- 
verity, bounded on the one hand by the mildest 
forms, in which there is present only pain, paras- 
thesia, etc., in the distribution of a single nerve to 
the more severe forms, in which there are present 
paralysis, anesthesia, pain, trophic disturbances, 
and tinallv the most severe forms, which show in- 
volvement both of the peripheral and central ner- 
vous system. 

The etiological factors governing the production 
of neuritis as result of pregnancy may be caused 
by any of the common agents that bring about 
inflammation of nerves at any other time, such 
as alcohol, drugs and other exogenous toxines, 
trauma, infectious diseases or extension of in- 
flammation from neighboring structures. 

These forms of neuritis do not diflrer in their 
histories from neuritis that occurs in the non- 
child-bearing individual. 

Tlie nerves chiefly involved are ( i ) those of the 
sacral plexus, (2) neuritis of nerves distant to the 
genital area (example ulnar), (3) a general 
multiple neuritis may follow, particularly in 
alcoholic subjects. 

Lauray makes three divisions of multiple neu- 
ritis seen as result of pregnancy — (i) traumatic, 
(2) septic inflammations by extension, (3) in- 
fectious neuritis from distant nerves, and often 
of the spinal cord. 

Below is given a very beautiful case of Kor- 
sakoff's syndrome, in which we have a patient 
with the most pronounced symptoms and signs 
of a severe case of multiple neuritis, with marked 
disturbance of memory for recent events, and also 
a disorientation as to time and place. From a 
very careful incjuiry of her surroundings, habits, 
etc., chronic alcoholism can be absolutely ex- 
cluded, and we must therefore acknowledge that 
in this case, at least, Korsakoff's syndrome can 



be caused by some other toxine than alcohol. 
Report of case is as follows : 

CASE II. 

Mrs. J. S., Westminster, S. C. ; age 33 ; mar- 
ried ; June 23, 191 1. 

Complaint. — Paralysis lower limbs; weakness 
and numbness upper extremities. 

Family History. — Negative. 

Past History. — Has always been healthy, al- 
though somewhat nervous; four healthy children; 
:\ugust, 1910, miscarriage; was sick four weeks; 
felt generally weak after same, but was able to 
look after her household. 

Habits. — Absolutely negative to alcohol and 
drugs ; very moderate as to coflfee. 

Menstrual History. — Normal. 

Careful inquiry into her surroundings, etc., 
failed to reveal any possibility of a chronic or 
acute toxemia of external origin. 

Present Illness. — Patient has never been really 
strong since her miscarriage in August, 19 10, al- 
though she was able to look after her household 
duties. In the fall of 1910 she again became preg- 
nant, and in December, 1910, she began to have 
vomiting spells, which occurred independent of 
diet. This condition gradually grew worse, and 
in January, 191 1, patient became confined to bed 
on account of weakness, persistent and almost 
continuous vomiting. 

In the early part of February, 191 1, she was 
taken to Atlanta, Ga., to a hospital, where the 
uterus was emptied. She remained there about 
one month. Vomiting ceased, but from the his- 
tory it appears that paralysis of the lower ex- 
tremities was discovered. Moreover, the patient 
says that she has absolutely no memory of her 
condition or her surroundings from the time of 
the operation until the latter part of April. She 
remembers nothing about the operation; has no 
idea or remembrance of the special nurse who 
was with her over a month, of the doctors or the 
hospital. When she again realized her surround- 
ings she felt as though she had been asleep, and 
that several years has elapsed since her sickness 
in January. At this time she realized for the 
first time that her limbs were paralyzed ; expe- 
rienced pain ; numb, cramp-like feelings in her 
hands, fingers and forearms ; pain and soreness 
in both legs. The two sides were symmetrically 
affected. Patient returned to her own home in 
the early part of March, where she was under 
the care of her physician until she came to the 



THE HOSPITAL BULLETIN 



University Hospital in the latter part of June, 
HJl I. 

Physical Examination. — Patient is very poorly 
nourished ; white woman ; seems to be in consider- 
able pain ; very emotional, crying almost con- 
stantly, which she says she cannot help; speech 
is normal ; memory marked amnesia for recent 
events, patient being unable to remember the 
name of the hospital for even the shortest pe- 
riods, the names of the nurses and doctors ; a 
few moments after receiving nourishment denies 
having received the same, etc. For remote 
events, for occurences precceding her visit to the 
hospital in Atlanta, her memory is very good. 

Examination of chest, abdomen and pelvis 
yielded negative results. 

Urine. — Quantitatively and qualitatively nor- 
mal. 

Blood findings are all normal. Stool negative. 
Temperature normal. 

Respiratory rate normal; pulse loo-iio. 

Motor Functions. — Complete flaccid paralysis 
of both legs : double foot drop ; marked weakness 
both thighs ; weakness of muscles of both fore- 
arms, grip being very weak. Atrophy of the 
muscles of all four extremities most marked in 
those which are paralyzed and in the weakest 
muscles. 

Contractures of the flexors of the leg, which 
prevent extension of the legs on thighs beyond an 
angle of 140 degrees; contractures of the pos- 
terior leg groups, which prevent the flexion of 
the feet or the legs to an angle less than no de- 
grees ; both great toes are markedly flexed and 
held in this position by contracture of their flexor 
muscles. These contractures exist on both sides, 
but are slightly more marked on the left. Trunk 
muscles and diaphragm are normal. 

No abnormal movements. 

Co-ordination of upper extremities poor ; of 
lower extremities not tested on account of paraly- 
sis. 

Reflexes. — Tendo-achilles and knee refle.'ces 
absent on both sides ; triceps present. 

Epigastric present : plantar stimulation gives 
rise to excessive but delayed pain, with no plantar 
flexion of toes ; Rabinski's sign absent. 

Rectal and vesical reflexes are normal. 

Sensory Functions. — Upper extremities tactile, 
pain and temperature sense are somewhat ob- 
tunded over hands, and lower part of forearm 
most marked in the peripheral distribution of the 



radial nerves ; muscle sense normal. 'J'runk 
showed no sensory disturbance. 

Lower Extreiiieties. — Tactile, pain and temper- 
ature sense are markedly disturbed ; disturbance 
of these senses varies from slight obtundations 
along inner side of thighs to more marked blunt- 
ing with incorrect localization on outer side of 
thighs and inner side of legs to delayed trans- 
mission and almost complete anesthesia along the 
outer side, posterior aspect of legs and dorsum 
and plantar surfaces of feet; complete loss of 
muscle sense of toes. 

Parasthesias. — Patient complains of numbness 
and tingling, burning and itching in all four ex- 
tremities; more marked in the upper. 

Nerves of upper and lower extremities are very 
tender to pressure; much pain of a burning, bor- 
ing character complained of in all four extremi- 
ties, more marked in lower. 

Vasomotor and Trophic Distnrhanccs. — The 
skin of both upper and lower extremities, espe- 
cially in their peripheral portions, is constantly 
covered with a cold profuse sweat : is pale and 
mottled in appearance, and feels cold to the touch ; 
nails of the toes are ridged and brittle. 

Electrical Reaction. — Upper extremities, 
muscles all react to faradic current, requiring 
stronger currents than normal to bring about con- 
traction of the small muscles of the hand ; lower 
extremities, anterior thigh group react poorly to 
very strong current ; anterior tibial group react 
to strong faradic stimulation of the nerve, but 
not to faradic muscle stimulation ; all other 
muscles of lower extremities fail to react to 
faradic current, but respond more or less char- 
acteristically to galvanic stimulation. 

Cranial nerves normal. 

Diagnosis of KorsakofT's syndrome was self- 
evident, and patient was placed upon proper 
treatment. Her improvement has been progres- 
sive ; left the hospital two months after her en- 
trance very much improved; sleeps well; has in- 
creased in weight ; no longer emotional ; pains 
are no longer a source of discomfort ; the use of 
the upper extremities for all practical purposes 
is normal ; sensation and motion are gradually 
returning to her lower extremities ; her memory 
for recent events is very much improved, and, in 
fact, is so good that it is almost impossible to dis- 
cover any lapses. She returns to her home to 
continue treatment, and her complete recovery 
is now only a question of a few months. 




DR. RUPERT BLUE 



THE HOSPITAL BULLETIN 



231 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, February 15, 1912. 



DR. RUPERT BLUE. 



The virility of the University of Maryland has 
only recently heen again attested in the selection 
of Dr. Rupert Blue, class of 1892, and D.Sc. 
(honorary), 1909, by President William Howard 
Taft as Surgeon-General of the Public Health 
and JNIarine Hospital Service. The appointment 
was won by noteworthy and meritorious service, 
which was especially evidenced in the suppression 
and eradication of bubonic plague in San Fran- 
cisco in 1907. The part he played in creating a 
clean bill of health for the Golden Gate City 
brought Dr. Blue prominently before the public 
eye, and when the President was casting about 
for a man to fill the vacancy in the Surgeon-Gen- 
eralship of the Public Health and Marine Flospital 
the executive ability of Dr. Blue as displayed in 
his various details was of such a meritorious 
character that of all the men in that branch of 
the Government service he was selected as the 
best fitted to direct its destinies for the ensuing 
four years. 

Dr. Blue was born in South Carolina in .1868. 
He was graduated from the University of Mary- 
land in 1892, and became an interne in the Marine 
Hospital Service during the same year. In the 
following year he was commissioned Assistant 
Surgeon, and in 1897 promoted to the grade of 
Passed Assistant Surgeon, and in 1909 to the 
grade of Surgeon. He was commissioned Sur- 
geon-General of the Public Health and Marine 
Hospital Service January 13, 1912. 



In 1903 and 1904 Dr. Blue was in charge of the 
Federal operations for the eradication of plague 
in San Francisco. In 1905 he took part in the 
suppression of yellow fever in New Orleans, and 
in 1907 was detailed as director of the sanitation 
of the Jamestown Exposition. In 1907 plague 
reappeared in San Francisco, and Dr. Blue was 
again placed in charge of the service work in 
California. 

Dr. Blue recently spent some time in Europe 
studying preventive medicine as practiced there, 
and in 1910 graduated from the London School 
of Tropical Medicine. In May, 1910, he was de- 
tailed to represent the Public Health and Marine 
Hospital Service at the International Congress 
on Medicine and Hygiene at Buenos Ayres, and 
at this time took advantage of the opportunity to 
study possible routes by which plague and yellow 
fever might be imported into the United States 
from South America. 

Dr. Blue's last detail before his appointment as 
Surgeon-General was at Honolulu, where he had 
been sent to act in an advisory capacity to the 
Hawaiian Board of Health and other departments 
of the Territorial Government in the carrying out 
of a program inaugurated to make the sanitary 
conditions such that the possibility of the intro- 
duction of yellow fever or plague into the Terri- 
tory after the opening of the Panama Canal will 
be reduced to a minimum, and its spread, if intro- 
duced, impossible. 

The Bulletin rejoices in the appointment of 
Dr. Blue, who ever since graduating has always 
been a credit to his Alma Mater, and extends to 
him, on behalf of the Regents, Faculty of Physic, 
alumni and undergraduates, their most cordial 
and heartiest congratulations on his well-earned 
promotion, and presage for him a successful and 
efficient administration. 



"THE ANTS ARE A PEOPLE NOT 
STRONG, YET THEY PREPARE 
THEIR MEAT IN THE SUMMER." 



The instinct of self-preservation is very strong, 
both in human beings and in certain of the lower 
orders of animal life. The squirrels industriously 
gather acorns and nuts, and lay them up for a 
time of need ; the bees flit from flower to flower, 
and extract honey for future use, and we have it 
from the wise man of old that "the ants are a 



23^ 



THE HOSPITAL BULLETIN 



people not strong, vet they prepare their meat in 
the summer." 

In institutional life the same instinct ought to 
hold good. If the institution has justified its ex- 
istence, and if its day of usefulness has not passed, 
it should take such measures as will insure its 
future. Most educational institutions, and espe- 
cially medical schools, are like the ants — ^"a peo- 
ple not strong," and yet they must "prepare their 
meat in the summer" if they wish to prolong their 
lives. Medical colleges are not mone3'-making 
institutions, and it is with great difficulty that 
they can meet their ordinary expenses ; moreover, 
the cost of conducting such institutions is con- 
stantly on the increase, and the entrance require- 
ments, as well as the qualifications for gradua- 
tion, are being constantly advanced. This means 
either fewer schools or fewer students, or both. 
It cannot be gainsaid that both the number of 
schools and of students can be advantageously re- 
duced. Every organization that has authority or 
influence in this direction is exerting its force to 
crush out the feebler schools, and to diminish the 
output of medical graduates. This means the sur- 
vival of the fittest. We must look the issue fairly 
in the face. Have we justified our existence, and 
do we deserve to continue to exist ? I must leave 
the question for others to an.swer. As an alumnus 
I think we have more than justified our existence, 
and that we should not permit our Alma Mater 
to perish for lack of sustenance. 

The faculty is devoting its energies to the reha- 
bilitation of the school, and its work is largely 
altruistic, but it is impossible for it to endow 
chairs, and it is only by the endowment of its 
scientific chairs that the future of the institution 
can be insured. Friends and fellow-alumni ! we 
must look to you to aid us in this our time of 
need. The need is urgent, the summer is short. 

The subscriptions to February i, 1912, are as 
follows : 

Robinson bequest $5000 00 

Dr. Hugh Hampton Young, J- H- U. . . 100 00 

Prof. R. Dorsey Coale, Ph.D 100 00 

Dr. S. J. Meltzer, LL.D., New York. . . 10 00 

Dr. Gideon Timberlake 25 00 

Dr. Gordon Wilson 50 00 

Mr. H. P. Ohm "10 00 

Dr. Samuel W. Moore, D.D.S 25 00 

Dr. A. Sagebein, D.D.S. , Cuba 5 00 

Thomas C. Basshor Company 10 00 

Hospital Bulletin 10 00 



Maryland Medical Journal 5 00 

Aliss C. M. Selfe 5 00 

]\Ir. George Lewis, Florid.i 50 00 

Mr. J. Henry Smith 25 00 

Mr. R. A. Krieger 5 00 

Summers Printing Co 15 00 

'Williams & Wilkins Company SO 00 

Geo. ^^'. Walther & Co 15 00 

Muth Bros. & Co 10 00 

Dr. John J. R. Krozcr, 1848 50 00 

Dr. Eugene F. Cordell, 1868 10 00 

Dr. John G. Jay, 1871 25 00 

Dr. C. R. Winterson, 1871 10 00 

Dr. Chas. IT. Diller, 1872 20 00 

Dr. Joseph T. Smith, 1872 10 00 

Dr. \\'. J. Young, 1872 25 00 

Dr. Isaac S. Stone, 1872 10 00 

Dr. Thomas A. Ashby, 1873 100 00 

Dr. David W. Bulluck, 1873 100 00 

Dr. Robert Gerstell, 1873 5 00 

Dr. Randolph Winslow, 1873 100 GO 

Dr. James \\'. Humrichhouse, 1873. ... 25 00 

Dr. II. T. Harrison, 1874 5 00 

Dr. John D. Fiske, 1875 5 00 

Dr. Wilmer Brinton, 1876 100 00 

Dr. Wm. E. Wiegand, 1876 10 00 

Dr. Thomas Chew Worthington, 1876. . 5 00 

Dr. R. H. P. Ellis, 1877 10 00 

Dr. L. Ridgely Wilson, 1880 5 00 

Dr. Charles S. Mitchell, 1881 100 00 

Dr. L. Ernest Neale, 1881 100 00 

Dr. E. L. Meierhof, 1881 50 CX) 

Dr. James M. Craighill, 1882 25 00 

Dr. J. M. Hundley. 1882 250 od 

Dr. I leiiry Chandlee, 1882 25 00 

Dr. Charles C. Harris, 1883 10 00 

Dr. Louis W. Talbott, 1883 25 00 

Dr. B. Merrill Ilopkinson, 1885 25 00 

Dr. J. C. Perry, 1885 100 00 

Dr. H. C. Reamer, 1885 10 00 

Dr. Frank Martin, 1886 100 00 

Dr. John R. Winslow, 1888 50 oo 

Dr. G. \V. McElfresh, 1889 100 00 

Dr. Joseph E. Gichner, 1890 25 00 

Dr. St. Clair Spruill, 1890 150 00 

Dr. Rupert Blue, 1892 100 00 

Dr. Frank J. Kirby, 1892 50 00 

Dr. Andrew J. Crowell, 1893 10 00 

Dr. Walter B. Kirk, 1893 5 00 

Dr. Martin J. Cromwell, 1894 50 00 

Dr. Charles T. Harper, 1894 So 00 

Dr. Henry Lee Smith, 1894 10 00 



THE HOSPITAL BULLETIN 



233 



Dr. Ilari-y Adler, 1895 100 00 

Dr. Jose L. Ilirsh, 1895 SO 00 

Dr. John McMullen, 1895 5 00 

Dr. Joseph W. Holland, 1896 50 00 

Dr. R. W. Sturgis, 1896 2 00 

Dr. Robert H. McGinnis, 1897 5 00 

Dr. Compton Riely, 1897 50 00 

Dr. Guy Steele, 1897 15 00 

Dr. Page Edmunds, 1898 50 00 

Dr. Albert J. Bossyns, 1898 5 00 

Dr. Edward E. Lamkin, 1898 25 00 

Dr. L. W. Armstrong, 1900 10 00 

Dr. S. Demarco, 1900 50 00 

Dr. M. S. Pearre, I9(X) S 00 

Dr. Irving J. Spear, 1900 50 00 

Dr. William Tarun, 1900 50 00 

Dr. John Houff, 1900 -5 00 

Dr. Wm. H. Smith, 1900 25 00 

Dr. J. D. Reeder, 1901 50 00 

Dr. Nathan Winslow, 1901 50 00 

Dr. Wm. R. Rogers, 1901 25 00 

Dr. Frederick N. Nicholls, 1902 15 00 

Dr. Arthur M. Shipley, 1902 250 00 

Dr. H. C. Davis, 1902 10 00 

Dr. H. L. Rudolf, 1902 25 00 

Dr. Wilbur P. Stubbs, 1902 5 00 

Dr. Hugh Brent, 1903 25 00 

Dr. Louis B. Henkel, 1903 25 00 

Dr. G. C. Lockard, 1903 25 00 

Dr. Geo. S. M. Kieffer, 1903 25 00 

Dr. H. J. Alaldeis, 1903 25 00 

Dr. Howard J. Iglehart, 1903 25 00 

Dr. Howard W. Jones, 1903 25 00 

Dr. John T. O'Meara, 1903 25 00 

Dr. Fred L. Wilkins, 1903 25 00 

Dr. Albert L. Wilkinson, 1903 25 00 

Dr. R. C. Metzel, 1904 10 00 

Dr. Ejnar Hansen, 1904 10 00 

Dr. Charles Bagley, Jr., 1904 25 00 

Dr. Alvin B. Lennan, 1904 25 00 

Dr. Walter Van Sweringen, 1904 25 00 

Dr. M. A. Weinberg, 1904 25 00 

Dr. Herbert E. Zepp, 1904 25 00 

Dr. Robert Bay, 1905 100 00 

Dr. B. F. Tefft, 1905 100 00 

Dr. Edward L. Bowlus, 1906 5 00 

Dr. Joseph A. Devlin, 1906 10 00 

Dr. W. F. Sowers, 1906 25 00 

Dr. R. W. Crawford, 1906 25 00 

Dr. Matthew L. F"reilinger, 1906 10 00 

Dr. Leo Karlinsky, 1906 20 00 

Dr. J. F. Hawkins, IQ06 25 00 



Dr. Richard C. Hume, 1906 10 00 

Dr. Frank S. Lynn, 1907 25 00 

Dr. T. H. Legg, 1907 5 00 

Dr. Albert H. Carroll, 1907 25 00 

Dr. Edgar S. Perkins, 1907 25 00 

Dr. W. Cuthbert Lyon, 1907 5 00 

Dr. Thomas H. Phillips, 1908 25 00 

Di-. J. N. Osborn, 1909 5 00 

Dr. E. H. Kloman, 1910 25 00 

Terra Mariae, 191 1 3 50 

Total $9445 5° 

Additions for the month, $170. 



ITEMS 



Dr. John Randolph Winslow, class of 1888, an- 
nounces the removal of his office to the Latrobe 
Apartments, Charles and Read streets, Balti- 
more, Md. 



The theater benefit given by the Alumni Ath- 
letic Association of the University of Maryland 
at the New Academy of Music Wednesday, Feb- 
ruary 7, 1912, from a financial standpoint, was a 
success. Full report will occur in next issue. We 
take this opportunity to thank our friends who 
patronized the play. 



At a recent meeting of the Howard County 
Medical Society the following officers were 
elected for the ensuing year : President, Dr. 
Frank Oldham Miller, class of 1902, and secre- 
tary-treasurer, Dr. Henry Dickinson Causey, class 
of 1911. 



MARRIAGES 



Miss Carlotta L. Shaefer, University Hospital 
Training School for Nurses, class of 1905, daugh- 
ter of Mrs. Elizabeth Shaefer of 3103 Abell ave- 
nue, was married to Mr. Thomas F. Murphy of 
the Rocks, Harford county, Maryland, January 
19, 1912, at the Cardinal's residence by Rev. F. 
D. McGraw. The bride wore a tan traveling suit 
and a corsage bouquet of violets. After the cere- 
mony Mr. and Mrs. Murphy left for Atlantic City 
and a trip North. On their return they will re- 
side at the Rocks. 



Miss Bessie May Reid, daughter of Mr. and 
Mrs. Samuel M. Reid, was married January 17 



234 



THE HOSPITAL BULLETIN 



at Brown Memorial Presbyterian Cliurch to Dr. 
George \\". Shipp, class of 1910, of Newton, N. 
C, by Rev. Dr. J. Ross Stevenson, the pastor. 
The bride wore a gown of heliotrope cloth and 
carried Bride roses. 

The ceremony was attended only by the family 
and a few friends of the couple. After the wed- 
ding Dr. and Mrs. Shipp left for their future 
home in Newton, N. C, where the bridegroom is 
a practicing physician. 



The marriage of Miss Louis Irene Craig, L'ni- 
versity Hospital Training School for Nurses, 
class of 1903, and ^Ir. James L'pshur Dennis was 
solemnized January 20, 1912, at the chapel of 
Emanual Protestant Episcopal Church by Rev. 
Henry Evan Cotton, rector. 

Mr. Samuel King Dennis, cousin and law part- 
ner of the groom, was best man, and Miss Mar- 
garet Dallas Craig, sister of the bride, was the 
maid of honor. The bride was given away by her 
cousin, Mr. Cassius M. Dashiell, of Princess 
Anne, Md. 

The bride wore a dark blue traveling gown. 
with a hat to match, and carried lilies-of-the- 
valley. The maid of honor wore a charming 
gown of old rose tussah and a black picture hat, 
and carried Golden Gate roses. 

The wedding was very quiet, no formal invita- 
tions or announcement having been issued, and 
only the near relatives of the two families were 
present. ]\Ir. and Mrs. Dennis left immediately 
after the ceremony for a short trip. 

Miss Craig is of the well-known Talbot county 
family of that name. Her father, the late Charles 
Page Craig, was a prominent business man of 
Cambridge, Dorchester county, where her brother, 
Mr. W. Grason Craig, and her sister. Miss Mar- 
guerite Craig, reside. Her mother (Irene 
Dashiell) was of the Dashiell family that has for 
many years been prominent in political and bus- 
iness life of the Eastern Shore, being a daughter 
of the late Nathaniel Dashiell of Somerset county, 
and a niece of the late Edwin Dashiell of Dor- 
cheter county, as well as a niece of the late Hamp- 
den H. Dashiell, for many years Register of Wills 
for Somerset county. 

Mr. Dennis spent his early life in Somerset 
county, but moved to Baltimore City about 20 
years ago. He is a younger brother of Judge 
John Upshur Dennis of Baltimore, and a son of 
the late L^nited States Senator George R. Dennis. 



He is a well-known member of the Baltimore 
bar, and was for a number of years secretarv of 
the Maryland State Bar Association. For 10 
years he has been a member of the faculty of the 
Baltimore Law School. 



Dr. Rufus Clark Franklin, class of 1907, of 
Graymont, Ga., and Miss Wyney Coleman, 
daughter of Islr. and Mrs. J. A. Coleman, of 
Swainsboro, Ga., were married on Wednesday 
evening, January 17, 1912, at the residence of the 
parents of the bride. 

The ceremony was performed by Rev. Grouse. 
The bridal party stood before an altar of hand- 
some ferns. Just before the ceremony Miss Annie 
Mae Smith sang "The Rosary." The first to 
enter were the bridesmaids. Miss Madge McLeod 
and Miss Rosalie Bell, gowned in pink chiflfon 
over pink satin and carrying pink carnations. 
They were followed by the dainty little flower 
girls. Misses Mattie Moring ^Mitchell and Mar- 
jorie Franklin, wearing frocks of pink crepe de 
chine. Master Graham Coleman was ring bearer. 

The bride entered with her maid of honor, Miss 
Mabel Coleman, attractively gowned in white 
chififon over satin, carrying a bouquet of white 
carnations. The bride was very attractive in her 
wedding dress of white satin with pearl trimmings. 
She carried a shower bouquet of white roses and 
valley lilies. 

Dr. Franklin was attended by his brother, Air. 
Paul Franklin, who acted as best man. The pop- 
ularity of the young couple was attested by the 
large number of handsome presents. 

Refreshments were served after the ceremony. 
Dr. and Mrs. Franklin left at 10 o'clock for a trip 
to Florida. On their return they will move to 
their home in Gravmont, Ga. 



Dr. Anton George Rytina, class of 1905, of 
2204 E. Monument street, and Miss Catherine 
M. Gier of Baltimore were married in Washing- 
ton, January 24, 1912. The ceremony took place 
at the Holy Comforter Church E. Capitol street, 
and was performed by the rector. Rev. Joseph A. 
Mver. 



Miss Margaret B. Proudfoot, formerly an un- 
dergraduate nurse in the University of Maryland, 
of Goderick, Canada, was married to Dr. Joseph 
E. Thomas, class of 191 1, of Tirzah, S. C, in Bal- 
timore, I'^ebruary 7, 1912. 



THE HOSPITAL BULLETIN 



235 



DEATHS 

Dr. Harry BaUKvin Gantt, class of 1880, of 
Millersville, Anne Arundel county, nephew of 
Rev. Dr. Charles W. Baldwin and Mr. Summer- 
field Baldwin, of this city, died at 9 o'clock Janu- 
ary 20, 19 1 2, at the Maryland University Hospital, 
where he had been since the early part of the week. 
Pneumonia is believed to have been the immediate 
cause of death. 

In September Dr. Gantt cut his hand while 
operating upon a patient in Anne Arundel county. 
Blood poisoning developed in the arm, and he 
spent several weeks at the hospital. He returned 
to his home to resume practice, but was compelled 
to come to the hospital frequently for treatment. 

About 10 days prior to his death pneumonia 
developed, and his physician again ordered his re- 
moval to the hospital. Here he was attended by 
Drs. Arthur M. Shipley, Lewellys F. Barker, 
Charles W. Mitchell and Gordon Wilson. Dr. 
Gantt's waning strength made it impossible for 
him to respond to treatment. 

Dr. Gantt was 54 years old, and he crowded 
into that time many activities which brought him 
before the public in various ways. His father was 
the late Benjamin E. Gantt, a farmer, who be- 
came Register 06. Wills for Anne Arundel county, 
and also a member of the House of Delegates. 
His father was superintendent of the Sunday- 
school of Crossroads Methodist Episcopal (now 
Baldwin Memorial) Church for 25 years, and was 
a man of national reputation in the early cam- 
paigns for temperance. 

The mother of Dr. Gantt was Miss Maria 
Eleanor Baldwin, the eldest child of the late Wil- 
liam H. Baldwin of Millersville. Both she and 
her husband died many years ago. Dr. Gantt, 
their only child to attain maturity, was a student 
at Anne Arundel Academy, one of the most vener- 
able and prominent schools in the State. 

Having been graduated from the academy, Dr. 
Gantt, attended the University of Maryland Medi- 
cal School, from which he received his degree as 
a physician in 1880. He became an assistant of 
the noted surgeon, Dr. L. McLane Tiffany, with 
whom he remained a considerable time. 

Country life appealed to Dr. Gantt, and he be- 
gan practicing at Millersville, his old home. He 
was married in 1884 to Miss Sue Adreon. Like 
his father, he was interested in the affairs of his 
county, and on the Republican ticket was elected 



Treasurer of the county about 10 years ago. He 
also served as a Delegate in the General yVssembly. 

He was employed as an emergency physician 
by the Washington, Baltimore & Annapolis Rail- 
road Co., and took a marked interest in the devel- 
opment of good roads in the county. His genial, 
whole-souled nature, love of home and friends 
made him one of the most popular men within a 
radius of many miles. Several of his ancestors 
were distinguished Revolutionary soldiers. 

Besides his widow. Dr. Gantt is survived by 
two sons. Dr. Harry B. Gantt, Jr., and Adreon 
Gantt, and three daughters, Mrs. J. Elizabeth 
Duker of Baltimore, Misses Sue Elizabeth and 
Margaret D. F. Gantt of Millersville. Mrs. 
Martha B. Morgan of Millersville is his aunt. 



Dr. Charles Garfield McDowell, class of 1874, 
60 years old, a well-known physician of this city, 
died at his home, 1521 W. Fayette street, January 
24, 1912, after a lingering illness. 

Dr. McDowell was born in New York State, 
and came to Baltimore when a boy. Fie received 
his early education in the public schools of the city 
and graduated in medicine from the University 
of Maryland in his early twenties. Fie practiced 
medicine in the coal regions of Pennsylvania for 
a short while, but later returned to Baltimore, 
where he continued the practice of his profession 
until a short time before his death. 

The funeral took place from his home. Dr. H. 
A. Criesemer, pastor of Franklin Square Baptist 
Church, of which Dr. McDowell was a deacon, 
conducted the services. Burial was in Loudon 
Park Cemetery. He is survived by a widow 
(Mrs. Ella E. McDowell). 



Dr. Louis W. Morris, class of 1885, of Salis- 
bury, Md., died at his home on N. Division street, 
Salisbury, Md., February 2, 1912. Dr. Morris 
was the son of the late Dr. L. W. Morris of 
Princess Anne, and was 46 years of age. He is 
survived by his widow and one son — Louis W. 
Morris, Jr. — and two sisters — Mrs. C. W. Wain- 
wright and Mrs. W. O. Lankford of Princess 
Anne. 



Miss Edna Hedges, a pupil nurse at the Uni- 
versity Hospital, died there of pneumonia January 
24, 1912. 



HOSPITAL BULLETIN 

OF THE 

UNIVERSITY OF MARYLAND 

VOLUME VII 

FEBRUARY 15. 1911— FEBRUARY 15. 1912 



CONTRIBUTORS TO VOLUME VII 



PAGE 

Ashbv, T. A., M.D 121, 141, 161, 181 

Asper, Burt T 84, 190 

Bacon, Walter C 88 

Bover, B. S 104 

Byerlv, W. L., M.D 72 

Carroll, Albert H.. M.D 27, 88, 1 

Devlin, J. A., M.D 106 

Dodson, Richard C lot 

Douglas, L. H., M.D -2 

Dries. C. L 150 

Edelman, James J 70 

Elderdice, J. M., M.D 49 

Gaither, Geo. R 71 

Giampetro, A. W., M.D 107 

Hemmeter. John C.. M.D 21 

Johnson, Edward Sooy 22s 

Kirk, Norman T., M.D 67 

Kloman, E. H.. M.D ■/2, 170 

Lee, S. E., M.D 72 

Linn, Willis 21 1 

McCall, Alvin Clay 8 



P.\GE 

]McDaniel, S. E 12 

McMillan. Roscoe D., M.D 31 

Mallen. Manuel E ^o. 172 

:\Iarett. W. C .'. . 27 

Massenburg, G. Y t 5 1 

Matthews, A. Aldridge, M.D i, 2g, 30. 81 

Neale, L. E., M.D .49, 72 

Nichols, E. E 27 

Oler, Vernon H 91 

Reeder, J- Dawson, M.D 206 

Roberts, "C. W., M.D 130 

Schmidt, Chas. L 31 

Schoenrich, Herbert, M.D 41 

.Strosnider. C. F., M.D 192 

Taylor, Ralph L 91 

Whims, T. Gay 69 

Wiley. Harvey W 6[ 

Wilkins, J. C 109 

Winslow. Nathan. M.D 21, 69. in 

Winslow, Randolph, M.D 126, 1477 

167, 187, 201. 221 



INDEX TO VOLUME VII 



P.\GE 



A Further Anthropometric Study of En- 
teroptosis — Reported from the Clinic on 
Diseases of Digestive Organs 

A Hurried Trip Through Europe 121, 

141, 161, 

Abstracts 14, 33, 54, 154, 175, 

Acute P'lexures of .Sigmoid and Colon Diag- 
nosed by the Proctoscope 

Address 

Of Dr. Harvey W. Wiley 

To 1911 Graduating Class 61, 

Adler, Harry 

Advisory Alumni Council 

Alabama Alumni 

Alexander, Lawrence S 



88 

181 
195 

206 

71 
61 

71 
175 

13 
178 
180 



PAGE 

Alien, S. M 176 

Alumni Association of the University of 

Maryland 191 1 Reunion 96 

Athletic Association 176 

Living of the Older Classes 53 

Jn W. S. P. H. and M. H. S 177 

.\merica. See First 126, 147, 

167, 187, 201, 221 
Amputation of the Breast for Mammary 

Cancer 211 

Anderson, Edward 197 

Anderton. ?L S 38 

Ano, Fistula in 172 



.\ppendicostomy in the Treatment of ^Vmebic 
Dysentery loi 



THE HOSPITAL BULLETIN 



237 



PAGE 

Arsenic Treatment of Syphilis Antedating the 

Modern Ehrlich-Hata 606 15 

Ashburv, Howard E 175 

Ashby,'T. A 18, 37 

Asper, Burt J 59 

Athey, H. B 198 

Atkinson. Robert 80, 99 

Autoenucleation of Fibroma Comphcating 

Pregnancy 106 

Bacterial Rot of Onions Caused by Bacillus 

Coli 107 

Bacillus Coli, Bacterial Rot of Onions Caused 

by 107 

Bagley, C, Jr 135 

Baker, Frederick B 80, 120 

Ballinger, E. G 78 

Bay, James H 157 

Bav, R. P 18, 140, 197 

Beil, Miss A. F 138 

Beltz, Theodore H .' ^ 99 

Benson, Benjamin R., Jf 158 

Berkeley, H. J 116 

Bernstein, E. J 119 

Betson. G. W 97 

Billingslea. C. C 135 

Births 39, 59, 98, 

158, 178. 199, 218 

Bispham, \V. N 215 

Blue, R. L 217, 231 

Bulluck. D. W 138 

Burroughs, Lay Gordon 91 

Bussey. B. F 1 19 

Bond. Allen K 59, 1 16 

Bond. Summerfield B 19, 219 

Book Reviews 40, 180, 220 

Boone. Wm. C. P 218 

Borden, William B 149, 215 

Bowen, Josiah Slicer 19. 38 

Brent, Hugh W 171 

Bverlv, W. S 39, 50 

Byrne. J. F 157 

Cancer of the Rectum 195 

Candidates Successful Before State Board, 

June. 191 1 117 

Cannon, A. E 117 

Carcinoma of Scalp 29 

Carrico, L 120 

Carroll. A. H 77, 115. 139, 197 

Carter. Henry R 21 

Carter. Miss L. B 136 

Case of Gastric Ulcer with Gastro-enteros- 

tomv Performed 91 

Of Persistent Vomiting Following Gas- 
tro-enterostomv Performed Five Years 

Ago ' 27 

Causey. H. D 233 

Cawley. W. D 19 

Cecostomv in the Treatment of Amebic 

Dysentery loi 

Chandlee. Henry T16 

Chaney, Joseph P 159 



PAGE 

Changes in the Medical Faculty 74 

Chapman, x^nne E 79 

Chappelier, F. DeS 179 

Chappelier, H. C 178 

Cliarge and Collect 93 

Chew. Samuel Clagget 20, 37 

Chambers, A. T 96, 134 

Clarke, A. B 37, 159 

Clarke, Miss E. P 78 

Clarke, S. R.. 
Class of 1865. 
Of 1870... 



98 
98 
98 

Of 1871 135 

Of 187^. 



156 

Of 1874 119 

Of i88s 37 

Of 1885 83 

Of 1897 77 

Clavicle, Fracture of Outer Third of 8 

Clinical Assistants 1911-1912 118 

Coale, Mrs. R. Dorsev 159 

Coale, R. D .' 118 

Codington, H. A 19, 59 

Commencement, The C)ne Hundred and 

Fourth Annual 74 

Complications of Gastro-enterostomy 51 

Cordell, E. F .'35, 135, 197 

Cox. N. H. D 140 

Craig. Louise 1 217, 234 

Craighill, J. M 156, 177 

Crouch, J. F 7, 17 

Crutchfield, E. Lee 96 

Daniels, W. H 217 

FJarling, Edwin G 99 

Dausch, Pierre G 200 

Deaths 20, 39, 59, 79, 

98, 120, 150, 179, 200, 218, 235 

Deaths in Year 98 

Defective Children 33 

Dees, R. E 32 

Dees, R. 32 

Deets, J. E 120 

Delashmutt. \'an E 99 

DeVilbiss, C. N 196 

Devilbiss, David M 20 

Devlin, Joseph Angelo 18, 134 

Diller, C. H 136 

Dispensary Report 7.4. 

"Do It Now" 153 

Dobbin, G. W 20 

Dodson, R. C 19, 157 

Dorsey. B. H 216 

Dudley. Norman S 218 

Dunderdale, Grace L 200 

Durkin. W. J 198 

Earle, Samuel T 54 

Echinococcus C\st of Liver — Symptoms and 

Surgical Treatment 190 

Editorials 13. 33- 53. 73- 93- 

113. 133. 153- 173. 194- 213, 231 

Edmunds. Martha V 218 



238 



THE HOSPITAL BULLETIN 



PAGE 

Edmunds, Page 157 

Edwards, T- B 197 

Efrid, L. j 197 

Endowment of the Departni&nt of Pathology. 33 
Enteroptosis, A Further Anthropometric 

Study of 88 

Europe, A Hurried Trip Through 121, 

141, 161, 181 

Famous, Chas. W 115, 178 

Fehsenfeld, Arthur L 218, 197 

Fibroma, Autoenucleation of, CompHcating 

Pregnancy 106 

Fisher, H. W 140 

Fistula in Ano 172 

Flanagan, Miss Nettie 78 

Fracture of Outer Third of Clavicle 12 

Fractures, Some Practical Points Regarding, 
with Special Reference to Internal Devices 

and the X-ray ,. i 

Franklin, Rufus C 118, 234 

Gamble, C. B 116 

Gantt. H. B 120, 198, 235 

Gantt, Robert H 100 

Garner, Miss J. R 217 

Gas Gangrene, with a Report of Two Cases. 130 

Gastro-enterostomy, Complications of 51 

Gastric Hemorrhage, Report of Two Cases 

of Fatal 81 

Gastric Ulcer, Case of, with Gastro-enteros- 
tomy Performed 9t 

General Alumni Association 1912 Banquet, 

197, 198 

George, Enoch 218 

Georgia Alumni 158 

Gephardt, Miss M. L 199 

Giampietro. A. W 1 18, 132 

Gibson. J. A 177, 210 

Gichner.'j. E 136, 157, 198 

Gilpin, George E 180 

Give Not Grudgingly, or of Necessity, for 

God Loveth a Cheerful Giver 173 

Glidden, E. W., Jr T7r, 

Gordon, Walter C 115 

Gourlev, Miss Henrietta }7, 157 

Gray, Oliver J 180 

Green, T- R 116 

Gribbie; O. S 158 

Griffith. Stephen H 99 

Gross, H. B 1 39 

Gunshot Wounds of the Spinal Cord 150 

Hafele, George W 79 

Hallux Valgus, Radical Cure of Painful. ... i [ i 

Hammond, R. L 140 

Hammond, S. W 1 34 

Hanes, J. Louis 38 

Hanna, Michel S 97 

Hansen, E 15. i35- ^77 

1 larbaugh, Harry V 200 

Hargrove, Robt. H 37 

Harper. C. T 156 

Health Officers 199 



/<- 



200 
120 

59 
1 8 



--.1 
220 



IWGIi 

Fledges, Edna 235 

Heggie, N. McLeod 178, 197 

Hemmeter, John C 18, 20, 78, 198 

Hengst, William F 200 

Henning, Emil H 17S 

Herrmann, Frederick H 158 

Herschner, N. W 215 

Hill, Norman F 52, 80 

Hoen, Adolph G 39 

Hookworm Disease in Its Infection Relation 

to the White and Colored Race 192 

Hollyday, John G 18 

Hopkins, Ephraim 1 16 

Hopkins, J. L 197 

Hopkins, William W 159 

Hopkinson, B. Merrill 117 

Howard, O. A 199 

Hubbard, B. H. B 

Hume. Richard C*. 

Humrickhouse, J. W 

Hussey, R. G 

Hyatt, Houston Boyd 

Hyperemesis Gravidarum and Neuritis Puer- 
peralis Resulting as a Sequela or Compli- 
cation, With Report of a Case 

International Clinics 40, 

Inversion of the Uterus, with a Report of an 
.\cute Case of Complete Inversion and Its 

Treatment 

Items 18, 35. 55' 77, 94. 

115. 134. 155- 176- 19^. 215, 
Jacksonian Method of .imputation of the 

Breast for Mammary Cancer 

Jarrett, Tames H 

Jenifer, "D. St. T 

Join the Throng 

Kirk, Norman T 

Kirk, Walter B i lO. 

Kloman, E. H 19, •//, 196, 

Krozer, John J. R 

Kunstler, Max 

Laboratory Report of University Hospital, 
18, 40, 60, 80, 100, 120, 160, 

Let L"s Add Your Name 

List You -As a Subscriber to the 

Pathological Fund 

Lewis, W. F 

Lilly, P. E 

Lippett, D. W. H 

Liver, Echinococcus Cyst of 

Tropical .^bcess of 

Living .\lumni of the Older Classes 

T.ockard. George C 

Louisiana .\lumni 

Lvon, Cuthbert 

McCain, P. P u), 

McCarty. H. D 

McConachie, .\. D 10. 

McComas, H. W 

McCormick. G. C 

McCormick. J. I 



170 

^33 

211 

57 
20 

114 
19 

197 
217 

57 
18 

220 
133 

173 

LS6 

38 

91 
190 

LSI 
53 
98 

215 
18 

59 
217 

38 
196 
no 
136. 



THE HOSPITAL BULLETIN 



239 



I'AGE 

• 235 

• 199 

• 217 
■ 19 

• 15s 
. 116 

• 59 
. 20 

73 
134 
140 

194 

59 

197 

20 



McDowell, C. C 

McEIfresh, C. W 96, 158, 

McElhatton, J 

McLaughlin, f . E 

McMillan, R. b 

McMullen. T 

Mackall, T. E 

Macks, I. M 

Mahle, George W 

Make Yonr \A'ills 

Maldies, H.J 20, 

Mann, Arthur H 

Many Mickles Make a Muckle 

Marett, W. C 19, 

Massenbury, G. Y 18, 59, 

Massenbury, Richard C 

Maternity. A Report of the Progre.ss of the 

New /2 

Matthews, A. A 38 

Maus, S. M 196 

Medicine and Surger\- in San Domingo so 

Metzel, R. C '. . .' 179 

Miller, F. 233 

]\Iilton. Joseph \' 219 

Miranda Joaquin S 18 

Missildine, J. G 199 

Mississippi Alumni 216 

Mitchell, C. W 18. 98 

Mitchell, Robert L 19. 52, 116, 158 

Morris, Lewis 120 

Morris, S. \V 235 

Morton's Toe 69 

Mullan, E. H 155 

Naylor, H. A 197 

Needs and Remedies 13 

Xevitt, Napoleon B 179 

New Requirements of the New York Board 

of Regents 113 

New Year, A 14 

Niblet, W. S 198. 217 

Nixon, Joel W 159 

Noble, C. P 14. 216 

Norris, Jacob D 60 

North Carolina Alumni 39, 55. 119. 136 

Nurses' Alumni Association 215 

Nydegger, James A 139 

O'Donovan. Chas 116, 120 

Older Alumni 94, 95 

O'Neal, W. PI 139, 166 

Owensby, N. M 177 

Parasitic Ameba of Man 180 

Parramore, W. V 19S 

Pathfinder in the Etiology- and Prophylaxis 

of Yellow Fever — Henry R. Carter 2 [ 

Pathology, Endowment of the Department 

of- ■ ■33- 53, 73- 93. 114, 133. 153' ^7?- i94. 213 

Patterson, ^Miss E. C 216 

F'earlstine. Kwv 1 79 

Pennington, John R 195, 216 

Perry. J. C 96, 116 

Peters. Colvin C 116 



PAGE 

Piggott, Cameron 80 

Piggott, J. Burr 132 

Pindell, Joseph T 79 

Pleasants, Miss P. C 78 

Poe Scholarship 214, 216 

Pole, A. C 137 

Proctoscope. Acute Flexures of Sigmoid and 

Colon Diagnosed by the 206 

Proudfoot, Margaret B 234 

Puerperal Eclampsia, Treatment of 31 

Purdum, H. D 215 

Radical Cure of Painful Hallux Valgus — 

With l^eport of Case in 

Rankin, W. S 2^. 137 

Ravnor, R. W .178 

Reeder, J. D 136, T78 

Reeves. John R. T 59 

Reik, H."0 737 

Relative Value of Cecostomy and Appcndi- 
costomy in the Treatment of Amebic 
Dysentery and Other Diseases Affecting 
the Mucous Lining of the Cecum and 

Colon, with. Report of Case. . . . '. loi 

Remarks on Medical Ethics 54 

Report of a Case of Sarcoma of Tibia 30 

Two Cases of Fatal Gastric Hemorrhage. . 81 
The Progress of the New Maternity.... 72 

Richards, G. H 19 

Riddick, W. J 20 

Riley, T. L 119 

Riser, "S. A 78 

Roberts, C. W 118, 178 

Robey, Miss Frances 158 

Rowe, Ernest H 200 

Russell, Miss Augusta 139 

Rutledge, Harry A 140 

Rvtina, A. G 234 

Sadtler, C. E 198 

Sappington. Richard 79 

Sarcoma of Tibia 30 

Saulsbury, Miss M. V 78 

Scalp. Carcinoma of 29 

Scarff. Marvel E 218 

Scholl. C. E 58. 59 

School, A Good, or None 153 

Schmidt, C. L. 59 

Scott, W. D 158 

See -America First. . 126. 147. 167, 187. 201, 221 

Seelinger, Harry R. 200 

Session, The 105th 153 

Seth, Louis H 19. 37, 197 

Shaefer. Carlotta L 233 

Shankwiler. Reed .\ 36 

Shipley, A. M 18 

Should .All Medical Students Seek Hospital 

-Appointments ? 46 

Simmons. H. M 1 16, 139 

Sinskey, Harry L 200 

Skin-Grafting. with Report of Two \'ery 

Successful Cases 84 

Skinner, Louis C 39 



240 



A'^t 



■ C^- 



.^ 



1^ ^ir' 

^ THE HOSPITAL BULLETIN 



p.' 



Smink, C. C 

Smith, G. E. M 

Smith, G. T 

Smith, WilHam S 

Smithson, Frank 

Soler, A. R 

Some Practical Points Regarding Fractures, 
with Special Reference to Internal Devices 
and the X-ray 

Sowers, Walter F , 

Sowing and Reaping 

Spear, I.J 

Speed Forth the Signal ! Clansmen, Speed ! . 

Spina Bifida — Its Pathology, Diagnosis and 
Treatment 

Spinal Cord, Complete Transverse Destruc- 
tion of 

Gunshot Wounds of the 

Spruill, H. Clair 

Squires, Miss Lucv B 

Stack, T. W ■ 

State Board (Md.) Report for June. 191 1 . . . 

Steiner, Ralph 

Stevens, S. A 

Stone, D. E 

Stoner, Harry W 

Stricture of the Deep Male L'rethra of Small 
Caliber 

Strohm. Miss F. .\ 78, 

Strosnider, C. F 

Students. Should All Medical Seek Hospital 
Appointments ? 

Subscription Card Party 

Surgery (and Medicine) in San Domingo.. . 

Sweringen, Walter Van 

Svmelus 

Talbott, S. W 

Talbott. Thos. J 

Taneyhill. G. Lane 96, 97, t20, 177, 

Tarun, W 

Tefift, B. F., Tr 

Terry, C. E.." 

Tetanus 

Thomas, John Enloe 19, 

The Ants Are a People Not Strong, Yet 
They Prepare their Meat in the Summer. . 

Tiffany, Louis McLane 

Timberlake. G 156, 

Todd, H. \V 

Townshend, G. D 19. 

Treatment of Acute Mania 

Puerperal Eclampsia 



166 
100 

38 
116 

139 



98 

73 

176 

-13 
104 

'54 

19 

37 
135 
'74 
'5-' 
156 
119 

83 

109 
218 
118 

46 
186 

5'^ 
7'» 
49 

138 
179 

198 

217 

10 

178 

8 

59 

231 

93 

197 

176 

59 
14 
31 



P.\GE 



Tropical Abscess of Liver 

Truitt, George W 

Tuttle, A. D 

Tyson, W. E. E 197, 

Twigg, William Franklin 

Uhler, John R 159, 

L'lcer of the Stomach or Duodenum 

University Flospital Staff 

Training School for Nurses, Commence- 
ment Class of 191 1 

University of Maryland's Record 

[University of Maryland Should Appeal to the 
State for Aid, and Should Receive It. . . . 

L'rethra. .Stricture of the Deep Male, of 
Small Caliber 

L'rticaria 

LIterus, Inversion of the 

Valentine, A. W 

Vinup 

A'^omiting, Case of Persistent, Following 
Gastro-enterostomy, Performed Five Years 
Ago 

\'on Drecle, John H 

\'an Poole, G. D 

Wall. Reuben A 

Walter, George 

Wasserman Reaction 

Warner, R. A 

\Vatch It Grow 

The Fund 

Watkins, D. A 

Webster, A. G 

Weed, F. W 

^^'hite, Walter W 

Whitehurst, M. M 

\\'iggin. Miss Mary C 59) 

Wilev, Address of Dr. Harvev W 

Willse, R. G '. 

Wilson, L. B 117, 

Winslow, Callender F 

Winslow, FitzRandolph 118, 

Winslow, John R 199, 

'VA'inslow, Mrs. Nathan 

Winslow. Nathan 96, 176, 

Winslow, Randolph 18, 19, 59, 78, 

79, 97, 134. .154, 177. 

Winslow, The Randolph. Scholarship 

Worthington, T. Chas 

Wright, E. B 

Wright, Josephu .\ 

\Wight. Miss A'era 

Zepp, H. E 

Zimmerman, Luther M 



15^ 
120 

157 
199 

7 

179 

175 
112 



114 

109 

67 

170 

37 

176 



27 
218 
140 

80 
"7 

41 
217 

93 

73 

197 

215 
156 
218 
20& 

78 
61 
176 
132 
196 
135 
233 
2t5 
198 

199 

33 
116 
197 
20 
78 
199 
160 





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